Sadism In Psychoanalytic Training

I must be honest that I had no idea how lucky I was to have had my unique entry point into psychoanalytic training. My first supervisor, while not overly warm or emotive, was genuinely kind and reservedly loving. The feelings I received from her in small and nuanced ways was “I understand your position and your protections…. and you are good enough.” I often wonder where I would be today had she taken the stance that so many psychoanalysts and psychoanalytic training institutes take… namely… if it doesn’t hurt really bad and activate your nervous system to the point of breaking you’re not learning anything. And if you are too weak to tolerate hazing and sadistic abuse, you still have work to do and you must dig deeper and talk more about it with the person abusing you.

I imagine that if this sadistic approach had been my introduction to psychoanalysis, I would have run… not walked… away from this training, analysis and supervision track I have been on for the last eleven years. I imagine had sadism been a justified default position of the mentors I’ve had, I would believe what so many believe about psychoanalysis. I would believe that it is a way in which powerful, narcissistic therapists take control over another person’s psyche, manipulate it and leave a patient dependent. I would believe it was an archaic form of mental health treatment akin to forced electric shock treatment or lobotomy.

But that was not my introduction. I admit that I wandered along in a very pretty bubble for the first few years of my training. I made the wrong assumption that, as a discipline, we had moved beyond these archaic ideas with the advances in Modern Psychoanalytic technique, Relational Psychoanalysis, British Objects Relations Theory, Attachment theory etc. When my very kind professor was asked if we should activate a patient’s negative transference feelings in order to access their aggression his answer was something like, “I assume that, by default of being human, I will activate the patient’s frustration just in the normal flow of the treatment without trying.” This mirrored my feelings exactly. To show up late for a patient on purpose to get them to respond so it can be analyzed felt narcissistic, abusive and manipulative. One might assume that I will accidentally come late at some point and we can explore it then. But to do so intentionally will absolutely be felt by the patient and, in my mind, constitutes abuse in the treatment. These are the fears that so often my patients have when they find out that I have been trained psychoanalytically.

My first experience with a professor who believed otherwise shocked me. His aggressive attacks on his students astounded me and his suggested interventions for clients was so deeply misattuned. I found myself shaking with rage in his course and the institute’s lack of response deeply shocked me. This is a feeling I had again this week as I faced an abusive sadistic Clinical Director of an institute. Truly, I admit to my naivete at the time, but there was a time when I simply could not imagine that any psychoanalysts could know of the advances we had made in the field— the research we had about the brain, trauma and attachment— and could still believe that purposely activating the aggression of the patient in sadistic ways was a viable and useful treatment method. My dear friends, I have found out just how wrong I was in this assumption.

Little by little I would hear stories of truly out of line sadism and abuse at the hands of psychoanalysts. In training programs, in process groups, in supervision and in individual therapy. And those brave humans who still trusted me to talk to them admitted to their own shame that they could not “work through” their responses to this abuse with their abuser.

Jiddu Krishnamurti was quoted to say some version of the following quote: “It is no measure of health to be well adjusted to a profoundly sick society.” So, I must ask: is it any measure of health to be well adjusted to a sadistic and abusive training or treatment environment?

Some— not all— institutes are hazing their students. And it needs to stop.

(Lest I be accused of arrogantly over simplifying the nuance of sadism in treatment, I will note here that sadism can be used in a helpful way in treatment. But sadism for the sake of sadism is not justified. Sadism in response to a relational need and done in the context of helping the patient feel known can be very useful in many treatments. But the dosage must be just right and I find it best to be done playfully instead of viciously.)

I decided to write this post because, while I never fully drank the Kool-Aid enough to tolerate sadistic behavior from an authority figure in the name of growth and learning, I have experienced the attempts to convince me that this type of sadistic abuse is the equivalent of psychological and educational rigor. And I have observed students being tortured by the idea that there is something wrong with them that they are catatonic after a process group where the leader allowed other group members to abuse them. These clinicians are making people crazy, not curing them.

This is not okay. And it is far from necessary. Nor is it how most of us wish to do our work with patients.

When I have patients who have been injected with the belief that they will only be good and stable people if they psychologically beat themselves up regularly, I often ask them if they believe my office plants would grow better if I punished them. It is such a simple analogy, but it gets to the core of it. Why would we think that abrupt and acute pain is anything other than trauma?

Does that mean that treatment or training should be easy and warm and comfortable all the time? No, of course not. Just as it is not comfortable for a child to ride their bike without training wheels for the first time, this work will not aways be comfortable. Nor should we aim for that. But there is a difference between throwing a child who cannot swim in the deep end against their will— laughing as they struggle to stay alive and gently encouraging a child who has said they are ready to remove the training wheels. One is trauma. The other is growth. There is a difference and the old guard of psychoanalysts would do well to take that information on board.

I spoke with my mentor yesterday and he told me that it is confounding to him that these institutes treat these new and curious students with such aggression and sadism and then wonder why they cannot fill their institutes with students. They wonder why no one graduates. They wonder why they have no certified analysts to supervise their new students. They wonder why Psychoanalysis is no longer relevant.

In fact, a search of analysts certified by the American Board of Psychoanalysis will show you that we have on average fewer than 5 certified psychoanalysts per state (with the distribution laying heavily on states like New York). Think about that for a minute. On average each state has fewer than 5 certified psychoanalysts! Try to think about how many licensed psychotherapists are just in your building— let alone city— let alone State. Only 5 per state?! All of the 5 certified in our State reside in Raleigh. Four of them are MD’s, the 5th a PhD. (What ever happened to Freud’s belief that the layman should be trained as Psychoanalysts?) . The blog post I wrote about structural elitism and racism in institutes is one reason. This sadism is another. We displace responsibility for this by blaming everyone but ourselves. We blame CBT, we blame immediate gratification culture, we blame insurance companies, we blame cartoons…

But, you see, psychoanalysis is still relevant! This project is proof alone of that fact. You would likely be surprised to find out how many new clients reach out to me specifically looking to “go deeper” and wanting to work with someone “Psychodynamic”. In fact, despite our bad reputation, there are still many people deeply curious about digging into the depths of their psyche. And as I watch this project grow, I am aware of how many new clinicians are also very interested in doing this type of work. It is not that psychoanalysis no longer holds a place in the hearts and minds of the people. It is that we still believe that the more pain, the more gain.

But that is not how the brain works. When our bodies are activated by fear or rage we do not learn anything other than how to have a reactive response to traumatic experiences. And we do not attach in a healthy manner. I will site some research here, but honestly every modern educator has this research at the ready. Every person with Instagram understands the neurological impact of fight or flight chemicals in the body and brain. Certainly psychoanalysts and psychoanalytic professors and clinical leaders have access to this research and are either choosing not to look at it or are simply ignoring it because it doesn’t fit with the way they believe to teach the craft with rigor. But, here is a study about the impact of parental criticism on intelligence. And here is a study on the ideal praise to criticism ratio.

I would argue that those clinicians and teachers who still believe that sadistic, hazing like behavior is beneficial for the clients are actively defending against their own shame about the harm that is done. They are doubling down. Possibly they have become convinced that the abuse they themselves suffered made them stronger.

But it didn’t. Finding a way to live and be a human following abuse may have put you in a unique situation for empathy. It may have allowed you to see your own capability and resilience. But it did not make you stronger. Abuse does not make people stronger.

And many of those who seek out the profession of psychotherapist have, themselves, already suffered enough abuse to have sufficiently gained empathy and a sense of their own capability and resilience. If our goal is to help our patients heal and help our students learn we must be the good enough therapists and teachers. In this way, their growth and learning can go as it should have gone. With the gentle encouragement to take off the training wheels. Not the sadistic path of throwing the child against his will into the deep end before he can swim.