Yesterday, Today, Tomorrow - Reflections on Psychoanalytic practice

Dr Richard Price
APAS Conference Panel
Thursday 5th October 2023, 11am

“Life can only be understood by looking backward but it must be lived (looking) forward.

Søren Kierkegaard 1813-1855

I came across this quote around the time of sitting down to write this paper and I thought it nicely captured both the title of the panel today as well as the title of conference overall. I was pleased to notice that the translation that I found, stated that it must be lived looking forward, while others I saw later translated more simply lived forward. I like both translations and how they capture distinct aspects of life; lived forward for me describes all the confusion and chaos of the moment. The constant struggle to make sense and contact with both our inner and outer realities, how to live our lives and make sense of it, faced with it all. It also brings to life the heart of psychoanalytic practice too, staying in the experience of being in the room. The challenge, in the moment, of following the patient, and yourself. The need to understand and survive, looking back and looking in.

However, when I read the other translation, Lived looking forward, I thought of my own analytic experience, something of the reimagined experience of myself as I approach the end of my analysis; looking forward talking to the emergence of a meaningful state of hopefulness brought about by that contact with another. Lasting connection with understanding and a willingness to be present.

This optimism was not always the case. If I take that story up from my first contact with, and perspective of psychoanalysis, it was in 1999. Having moved away from general medicine, I suspect due to unmetabolized feelings of the horror and helplessness of a newly minted doctor, confronted by all that cannot be cured. I was a 26-year-old first year psychiatry registrar, and as part of psychiatry training, I was asked to attend and bring material to once-a-week group sessions to the analyst John Malcom Davis. John was part of a Prince Henry’s hospital group of analysts that had moved their work to Monash Medical Centre, a large hospital in Clayton, a south-eastern outer suburb of Melbourne, when Prince Henry’s had closed. These sessions with him were in preparation for undertaking the psychotherapy long case, a one year, once a week, supervised psychotherapy treatment experience that remains part of psychiatry training requirements. My vague memories of that year are largely of my own, and others, considerable contempt towards, and attacks upon, the analyst and any notion of thinking about our experience. I would forget sessions, arrive late and unprepared, with complaints about the relentless demands, and lack of space for patient admissions, discharge summaries and writing prescriptions and how there was no time for this and nothing important to talk about. I don’t think I found much space for myself to think with John Davis, yet my main impression of that year was his capacity to bear such aggression with patience and sympathy.

I was not alone in these attacks, and they caused real damage and at the end of that year Monash Medical Centre’s psychiatry clinical director sacked the analysts that were working there. All part of the “mainstreaming” psychiatric revolution, I imagine it represented an attack on thinking in psychiatric public hospital care that has never been repaired. 

Thankfully, in hindsight, the hospital realised they still needed analysts to supervise the psychotherapy long cases and John Coleman and Frances Thomson-Salo continued to work there to support us. Once we had completed our psychotherapy long case and graduated, I continued to be supervised by John. He ran a Balint style group with of the early carer psychiatrists. It evolved into him supervising us with our supervision of the registrars doing their long psychotherapy case.

To explain the significance of John Coleman’s supervision and impact on me in my time as a registrar and pre-analytic training psychiatrist, I am reminded of having lunch out with my father, a retired surgeon, on Father’s Day this year. My dad has remained a passionate and lifelong Essendon football club supporter and I decided to give him the illustrated history of the Essendon football club, a dusty bound volume that I had somewhat miserly collected from a pile of books my mother-in-law was throwing out. My dad clearly loved the gift, and as he turned over the pages at the restaurant, he arrived at his childhood hero, John Coleman, the Essendon full forward who is considered by many to be the greatest of all time, famous for his high-flying leaps and spectacular marks. Coleman’s carer was cut short at the age of 25 due to a knee injury, but the Coleman medal is now given to the highest goal kicker in the AFL each year. Feeling quite moved, I tried to explain to my dad about the John Coleman that was so important to me. I told the story John had once explained to me, that he had met his famous namesake as a boy of about 10, as “the” John Coleman was to be married the next day. 10-year-old John appeared in a photograph on the front of the Herald tipping his hat to the famous footballer and his future wife. Although as a child John said he had loved that moment, he insisted that his real hero was Herb Henderson, the greatest full back of all time, from his team, from his own western suburbs beginnings, Footscray, and that he never saw Coleman play well, as Henderson was always there to spoil his high-flying game.

Thankfully the analyst John had a longer carer than the footballer, as it took me 15 years to ask about the Melbourne Institute for Psychoanalysis. When I finally did enquire about training, he explained with joy, the little building, he said that was formerly a butcher’s shop, on Tooronga Rd, Hawthorn East, that he had stuck the plaque, with the name of the Melbourne Institute, on the door. He was always calm and encouraging about his analytic training experience, always describing it as achievable and transformative.

Under the guise of imagined high flying training, but also unconsciously seeing no other way into an analysis, I met with Liz Orr, tripping over her rug with enthusiasm and shame, on the way in to enquire about starting an analysis and the possibility of training. Last year, at my first zoom meeting as an analyst with the institute, it was discussed that there were no training analysists available at that point to take on new candidates, and I was struck by the profound significance that so many doors were opened to me following that meeting with Liz that I had somewhat taken for granted.

Although, again, I didn’t know it at the time, I think I was quite fortunate to enter training quite naive to what was ahead. I had almost no psychoanalytic knowledge or experience other than my supervision with John which had been very focused on the experience rather than theory. I think it was a very challenging privilege to have my experience evolve in its own way, especially starting off with the infant observation chaired by Liz. The mother of the infant I observed was also a medical specialist, working in antenatal intensive care. It was a very close contact with the tiny, damaged, and as yet unborn infant. 

I was married with 3 still quite young kids and working mostly at a community mental health clinic that was part of Monash Health. I did have a small one day a week private practice, but the bulk of my work generally was working closely in the chaos of psychotic and severe personality problems. Mirroring my own internal experience, I had no idea where to begin and how much needed to change. I have found a way to emerge from what really was a war zone, but it did provide me with a lasting impression of, and interest in, these states of mind. It’s unfortunate that public hospitals now appear reluctant to allow analytic candidates, who would like to, to spend time on the wards as it is experience, I now see as invaluable. 

It’s not something straightforward to recommend. When I recently talked with Frances Thomson- Salo about working around the same time on the mother baby unit, I was reminded of just how silently overwhelmed, upset and angry I was most of the time, particularly when babies were not infrequently taken from the care of their mothers, and how much supervision with an analyst had helped me survive the madness and give me some space to process what was happening.

Some of the key events come to mind about my experience as a candidate are;

That I was fortunate to start my training in 2016 pre COVID. To have had four years of meeting in person, as a small Melbourne cohort, and with the larger Melbourne and National candidate group felt essential. So much was lost in the informal contact, fun and support of the candidate group once everything went online. I was grateful that training could continue, and facing feelings of deprivation, contamination and exclusion were difficult, necessary, and very significant for me in it all, but I do wonder if it would have been possible for me if training had started in lockdown and online. It felt at times in COVID lockdown that the training, work and my analysis went on, but life had stopped. I think I bunkered down into the cold comfort of all work and no play.

Preceding and through COVID there were the issues of other psychiatrist candidates not progressing or leaving training early because of ethics issues. We were all shocked and confused by Michael Waring’s suicide. It stayed with me that after an interstate weekend he spoke to the candidate group in his last email to us with the Yeats poem “The Second Coming”. It reads in part;

Things fall apart; the centre cannot hold;

Mere anarchy is loosed upon the world,

The blood-dimmed tide is loosed, and everywhere   

The ceremony of innocence is drowned;

We did not understand it at the time.

COVID itself also thrust us all into uncertainty and chaos. In my training all this created considerable anxiety and required huge adjustments, but it was my experience that the various structures of training worked well in containing me and the group which remained supportive and cohesive. I did find the experience of separateness from the analysts, frustrating and limiting, but was surprised on graduation how much the efforts that had been put in by all the analyst group, though the relationships formed though training, lead to a much more comfortable and familiar than anticipated transition into the analyst society. With the resignation of Liz Orr and the apparent absence of other senior as well as more recent graduates, I was left with the impression however that the kids may have been looked after through these challenges, but that the parents did not fare so well.

The time pressures of training for me personally, particularly as a dad, were significant. Looking back, again, there are so many things that I could have been less difficult, however the demands emotionally, financially and the impact on relationships of the time commitment required, need to be kept in mind when curriculums and training expectations are being developed. Particularly early in my analysis, the possibility of a balanced life outside work and training felt very difficult.

I personally benefited greatly from the establishment of the Winn Clinic. As I transitioned to full time private psychoanalytic practice it was an invaluable resource of thoughtful and appropriate referral that reached out into the broader community. For example, being able to refer me what became my second training case training case; a distressed artist, and now mother, who was on a low income has been a generative experience for me and the patient.

I initially felt quite sad and disoriented completing my training. The pleasure of returning to Sydney for my first in room ISWE post COVID for my final presentation also amplified my feeling of anxiety and loss of a supportive and valued candidate group. I was very grateful that this appeared to be understood and anticipated and I quickly felt invited into the rewarding transition to an analyst peer group and society events and roles. I think my fantasy was of a vast and expansive group, a well-resourced branch and society particularly in terms of numbers, so it has been a bit of a shock to recognise the extent of the voluntary work a relatively small group of people have been doing. I have found the issue of taking on too much, more of a concern than any fears I might have had fitting in. 

I have really enjoyed being a junior member of the scientific committee this year and contributing of the formation of CARO (Crisis and Responders Outreach). Being part of developing a conference and a not-for-profit analytic outreach service, has allowed me to quickly build relationships with members with vast experience across the society which I appreciate greatly.

To conclude, returning to the title of the panel; reflecting on psychoanalytic practice, and particularly its future or reimaging the future, I can indulge in a slight reimagining of Kierkegaard; Looking forward, through developing the capacity to look inward and back, through an experience of the other, is the cornerstone of what becomes possible through a personal and training analysis, and analytic training more generally. I suspect this hasn’t, and won’t change, and remains fundamental to life and psychoanalytic practice. With my analyst, and ongoing supervision with Hugh Garner, which we last did while he was abroad from somewhere near Thebes, their patience with me, staying with the transference, has been transformative and continues to surprise and reward in its complexity yet simplicity.

Harriette Wolfe talked at this conference of the analytic work being done in a refugee village in Darmstadt, Germany yesterday, and I am introducing a short film about that place and the work there on Sunday as part of the CARO panel chaired by my other supervisor Viv Elton. The film documents the experience of a handful of refugees who found a home and analytic support in that village. It’s a very moving testimony from these people, they talk of the soul-destroying impact of being homeless and dehumanized, coming out of their war zones, eaten away by the experience themselves as alien and unwanted. They all talk of the profound impact of someone having the capacity to listen to their experience, and in that, finding a home for themselves. It’s a sentiment I very much identify with, I feared it was impossible for myself personally and in my early career as a psychiatrist. I feel I have arrived here as an analyst at a time where the ongoing existence of an alive and growing psychoanalytic society can’t be taken for granted. With humanity faced with internal and external worlds increasingly threatened by war, isolation, environmental disaster, artificial intelligence, and empty experience, has never been more needed. 

Looking back on this talk, I think I am trying to tell you about all the rich and varied relationships with analysts that I have been fortunate enough to encounter in my life so far, and look forward to continuing. Any ongoing theoretical agnosticism about which psychoanalytic school of practice I belong, comes largely because of my experience of support, learning and growth from such a diverse array of people. A gratitude towards a collective society that provided me with a personal and profound training experience. I hope that my training experience represents a point in history, for our society, that is increasingly comfortable with an evolving breadth and diversity of psychoanalytic thought. Where, through reflection, possible rivalries, and differences, have not impeded an ongoing atmosphere of openness, growth, support, curiosity, respect, and trust that I have valued so much.

Thank you all.