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Abstract
This paper offers an outline of the theoretical dilemmas, clinical debates and challenges of diverse contexts in the training of psychoanalytically orientated psychotherapists in contemporary South Africa as well as globally. Radical changes to the delivery and funding of health care generally, and mental health care in particular, have had significant impact on access to, and the practice of, psychoanalytic psychotherapy globally. The crisis facing psychoanalysis in a world plagued by the tyranny of managed health care and demand for instant results has international relevance. Most South Africans have limited access to long term psychoanalytic therapy or psychoanalysis. This needs to be acknowledged as a crucial factor in determining the relevance of training models in psychoanalytically orientated psychotherapy. Given that the majority practice of psychoanalytically informed psychotherapy both in state settings and private practice constitutes the use of psychoanalytic concepts, applications and ideas rather than long term classical psychoanalysis, it is crucial that this should determine the nature of training current psychodynamic therapists should receive. The focus will specifically be on the clinical practice and training of psychoanalytically orientated psychotherapy as it is practiced by a range of practitioners including social workers, psychologists, general practitioners, psychiatrists, sub-specialist child psychiatrists and others.
Introduction: The perilous state of psychoanalysis
Any perusal of current psychoanalytic journals, texts or books will leave the reader in no doubt about the state of peril in which psychoanalysis finds itself today. The list of woes is deeply depressing and the recommendations for survival are often even more so. The current attitudinal climate is characterised by a significant denigration of psychoanalysis in popular culture, a loss of prestige as a profession and wholesale attacks from revisionist critics of Freud whose prejudices against psychodynamic psychotherapy usually far exceed their actual knowledge of contemporary practice (Shedler, 2010). There are significant challenges to psychoanalytic practice from alternative psychopharmacological interventions and cognitive behavioural therapy approaches, with demands for shorter term, more cost effective treatments from medical aid insurance companies. (Bornstein, 2001; Eisold, 2003; 2005; 2007; Fonagy, 2003a; McWilliams, 2000; Patrick, 2010; Prince, 2005; Shedler, 2010). Authors have noted the decline in numbers of students expressing interest in training in psychoanalytically orientated psychotherapies, a reduction of psychoanalytically orientated academics occupying university chairs, a disturbing discouragement...