A conference on the impossible tension of dual-role relationships suggests that we are deeply torn by such relationships and yet we cannot avoid them.
Introduction: A conference on the impossible tension of dual-role relationships suggests that we are deeply torn by such relationships and yet we cannot avoid them. We know that in training some relatedness between candidates and analysts is vital, and we also know, (or should know), that the power imbalance between candidate and analyst makes relatedness problematic. In this talk Iplan to look at dual-role relationships in training: what they are, the problems they cause, and what steps we can take to make training both safer and more productive. My focus today is meant to be descriptive and practical.
Dual-role relationships have a long and inglorious place in the history of depth analysis. John Kerr's book, A Most Dangerous Method, is a case study in how the combining of personal analysis, training, friendship, erotic entanglement and power politics can tear apart the most welI-intentioned professional association of analysts. Freud and Jung attempted simultaneously to be each other's analyst, colleague and consultant. When they attempted to analyze each other by sharing dreams, neither would tell the other the truth. Freud refused to share his dream associations for fear he would lose his authority; for Jung, that was the end of Freud's authority. Jung then told his dream of descending from deeper to deeper levels within a house, reaching finally two skeletons at the very bottom. Jung intuited the meaning as referring to his growing awareness of the collective unconscious underlying the personal unconscious. He intuited also that Freud would not accept Jung's independent thoughts which differed from those of Freud. Freud implied that the skeletons referred to a death-wish Jung had towards Freud. (Not a bad intuition on Freud's part!) To throw Freud off the track, Jung dissimulated and replied that the two skeletons associated to Jung's wife and her sister. (John Kerr thinks that this association was an indirect reply to Freud's refusal to associate to Freud's dreams, since Jung had learned from Freud's wife's sister of an affair between her and Freud). "Oh what a tangled web we weave when first we practice to deceive!" Freud and Jung's dual-role confusion of being each other's personal analyst, colleague and consultant contributed to mutual distrust and mutual failure of personal analysis.
The most poignant dual-role relationship described by Kerr is that of Carl Jung and Sabina SpieIrein. They began with Spielrein as Jung's patient. Quickly enough she came to be simultaneously his student, colleague and according to her diary, lover. The result was confusion and suffering for both. When Jung turned to Freud for help, Freud threatened to use Jung's confidences as a weapon against him in their political struggle for dominance within the psychoanalytic movement. Sabina SpieIrein's needs for personal analysis were misplaced in the ensuing confusion.
Scripture tells us that the sins of the fathers can be passed on to the children, yea unto the third and the fourth generations. Just as the early psychoanalytic pioneers conflated personal analysis, training and political alliances, so in recent years we have had to struggle with the same issues. In 1989 my analytical society's conference focused upon "Closeness". From that conference emerged "Closeness in Personal and Professional Relationships", edited by Harry Wilmer. All of us need to review what that book contains, because unfortunately our memories are short. Every few years we have to re-discover fire, perhaps by learning that we burn our fingers when we're not careful! So once more we examine what it means to relate as analysts and as candidates within an analytic training program.
Let us consider dual-role relationships in training, specifically, what dual-role relationships are and why they can be problematic. Second, we'll examine the many forms such relationships may take within an analytic society. Third, we will explore what attitude to take and what to do.
This presentation is a call to reflection. I realize that the issue of dual-role relationships carries legal and ethical implications. (During the years I served on an ethics committee, most of our interventions with analysts involved analysts being ethically compromised by a dual-role relationship, with an analysand or a candidate). I know the legal and ethical issues have to be taken seriously. Nevertheless, there exists the risk of responding to emotionally charged issues by trying to abolish evil. I don't want to stir a lynch mob to hang the sinners because, folks, we are all sinners! Instead of condemnation, what we all need is compassionate understanding.
Definition: Role theory from social science is related to but not identical to the concept of the Persona. Jung thought of Persona as having an archetypal basis. The Persona is the social self we present to the world and it may vary depending upon the social circumstances. As we live in a social reality, Persona is a necessity. "Identifying with the Persona", or imagining oneself to be only one's social roles, can be a problem. Persona is not itself a problem, nor is it superficial.
Persona looks at social relatedness from the standpoint of the individual person. In contrast, social role theory looks at the pattern of relatedness between individuals within a society. Roles are goal-directed configurations of transactions between people within a social context. Roles mediate the interaction of oneself with the self of another. Roles have limits and boundaries. Intimate relationship between persons exists within the possible limits of the role system. It is in appreciating the limits that intimacy itself is enhanced. A safe and satisfactory relationship between two persons develops when each relates to the other in a trustworthy manner within the context of their social roles. For example, if a candidate approaches an analyst to request control supervision, each has a role to perform. The candidate agrees to meet, present clinical material, pay the fee, and allow the analyst to send evaluations to a review committee. The analyst agrees to meet, accept the fee as payment, offer professional consultation and evaluation, and (except to the review committee) protect the confidentiality of the candidate and the candidate's patients.
A dual-role relationship exists when two persons simultaneously participate in more than one social role with each other. Such dual roles may or may not interfere with each other. If the existence of a role interferes with the performance of another, the dual-role relationship is problematic. For example, the candidate seeking supervision and the analyst may share an interest in which wine goes best with fish, or may share a taxi ride, or may both attend the same professional society meeting. Such shared activities generally would not interfere with supervision. However, should the candidate and analyst share other financial arrangements such as office rental, or be personal friends or lovers, then the objective evaluation of supervision would be compromised.
A dual-role relationship in training within an analytic society exists when a trainer, (generally an analyst), and a trainee, ( generally a candidate), have an additional relationship beyond that of trainer & trainee. The dual-role relationship is problematic for training if the additional relationship in any way compromises the training relationship.
The definitions above are relatively straightforward. As we examine what really happens in training, things become complicated. By the end of this section I will have suggested that dual-role relationships in an analytic training society are ubiquitous, unavoidable, variably problematic, and need to be taken into account for the training to be satisfactory. To get a conceptual grip on the types which exist, I will describe them as primary, derivative, unconscious, and by proxy.
Primary: Primary dual-role relationships are the sort of conscious, straightforward conflicts most of us quickly think of. The most obvious is when a personal analyst attempts to be involved in the training & evaluation of a present or past analysand. Involvement of the personal analyst, present or past, violates the confidentiality of the analytic container and violates the objectivity required for training evaluation. I stress that past analysts should be excluded from evaluating the candidate because I have heard confusion on this. I have heard analysts say "Well, we worked together years ago, but the transference was resolved". In my opinion, a meaningful analysis involves such deep revelation, regression and trust that there never will be a future time when the analyst should reveal what was shared. The confidentiality of the analytic container is a sacred trust, and the analyst should take those secrets to the grave.
While the prohibition against analysts' participating in training evaluations of their current & past analysands seems absolute, it is more debatable when issues of didactic learning are involved. Should the analysand attend their analyst's seminar?, lecture?, read their journal article? Well, it all depends. Hopefully the analyst and analysand will talk over the meaning of such questions in analysis.
Other examples of primary role conflicts would be when the training analyst has a pre-existing personal relationship with the candidate, such as friendship, lover, or business partner. When the relationship is pre-existing prior to training, the obvious solution is for that analyst to recuse themselves from evaluations of the candidate.
A more complicated problem arises when a training analyst and a candidate develop a dual-role relationship after the training has started. The prolonged contact, intimate and trusting communication, and shared values may lead to a desire for a more personal relationship by either the analyst or the candidate. Our ethics code is explicit about dual-role relationships between analyst and analysand, but silent regarding analyst and candidate. A society needs to make its expectations clear. Because of the power differential between analyst and candidate and because of the role conflict between objective evaluator and friend/Iover, I feel that it is unethical for an analyst to use the position of trainer to cultivate or "groom" a candidate for gratification of the analyst's personal needs.
Of course we need to use some common sense about relating to each other. Several years ago analysts and candidates were so concerned about overstepping boundaries that they avoided each other in the hallways. When we are sensitive to the primary responsibility of training, and the feelings of each other and of our colleagues, problems don't occur. With such sensitivity analysts and candidates can relate personally. When the needs and boundaries of the other are respected, problems don't occur. Problems occur if the more powerful member of a dyad attempts to exploit the more vulnerable for personal gratification.
Derivative: Primary dual-role relationships may be problematic, but they are not too difficult to observe or understand. Now I want to consider three other categories that are less obvious. The first is what I call derivative dual-role relationships. From time to time someone may remark that an analytic society is incestuous. What I think the "incestuous" remark refers to is that so many of our analysts and candidates have been in analysis or supervision with each other. At a recent meeting of a seminar I'm involved with I noted that all but three of the analysts present had been analyzed by one or another of the other analysts in the room. If you included supervision, then all present had at some time been in analysis or supervision with some other analyst present in the room. Remember that the revelations and trust from analysis and from supervision create the need of a secure container that lasts forever. Nevertheless, there we were trying to work as colleagues and equals even though we all had dual-role relationships with one or more fellow analysts in the room. That, my friends, is incestuous! Derivative dual-role relationships within a training society create the problem of how to work as colleague, equal and sometimes friend with analysts who previously have been analysands or supervisees.
Derivative dual-role relationships create another training problem. We know that what an analysand says to their analyst is to be kept confidential; analysis depends upon this. Yet candidates may be in analysis with analysts who themselves have been in analysis and supervision with other analysts in the same analytic society. What happens to confidentiality when a candidate's analyst has discussed the candidate's analysis with the analyst's analyst or supervisor? (We need a blackboard to diagram this). This creates a second order or derivative dual-role relationship where the analyst's analyst or supervisor then knows secrets about the candidate. If the second analyst participates in training evaluation of the candidate, there is a violation of confidentiality of the candidate's analysis and an unsafe distortion of the training evaluation.
I told you dual-role relationships would get complicated!
Unconscious: Another category of dual-role relationships are those which are unconscious; being unconscious, it is hard for the persons involved to recognize them. In an earlier paper on supervision I suggested that supervisors and supervisees can develop the full range of transference projections upon each other. This occurs because of prolonged contact, intimate and open sharing of emotionally meaningful material, and mutually shared values. Over time the supervisor or supervisee may develop parent-child feelings, erotic attraction, or come to see the other in some idealized way.
The most intractable projections are those which Kohut referred to as narcissistic transferences. These include idealizing, mirror and twinship transferences:
Idealizing: Either the supervisor or the candidate may project an idealizing transference onto the other. Since it feels good to be viewed as wise, good, and heroic, the recipient of the projection may question nothing. These situations may lead to the candidate's overvaluing the supervisor, loss of the ability to see weaknesses and shortcomings, and a type of enslavement in which the candidate blindly follows his or her ideal while attacking analysts who have different points of view. I suspect that it is from such unanalyzed transferences that psychoanalytic "schools" based upon the Great Founder surrounded by devoted disciples have evolved.
Mirror: In the mirror, (or self-object), transference the projector expects the recipient of the projection to mirror back what the projector wants to see of himself or herself. The projector wants to be idealized and may become enraged if this is not done. Supervisors and candidates may project such transferences upon each other. The supervisor may expect the candidate to be a mute witness of the supervisor's brilliance and skilI. Conversely, the candidate may expect the supervisor to say nothing while listening in silent awe to the superb presentations of the candidate. As you may expect, efforts to correct shortcomings may be met with resentment.
Twinship: In the twinship, (or alter ego) transference, the projector wishes the other to be a double of himself or herself. Again, such projections may occur between supervisor and candidate. A supervisor may act as if "we are all equal," as if no power differential exists. Such a supervisor might view candidates as his peers, friends and confidants. A candidate might treat his supervisors similarly. While it is true on a level of basic humanity that we are all equal, it is delusional to have such a belief about supervisor and candidate. Built into the very role each has in relation to the other is an inequality, a difference. To ignore such differences is to blind themselves to the reality of what each is required to do for the other.
Unconscious projections between analyst and candidate create an unconscious dual-role relationship. The projector may fee! love, rage, desire, or awe toward the recipient of the projection. Sadly, the actual other person is not known as he or she really is. As Elie Humbert describes it, the projector is "in pursuit of his own desire." With such projections intact the other is known as an extension of the projector's needs rather than as a person in their own right. This interferes with the analyst and candidate being able to relate accurately in their training roles.
By proxy: Yet another pesky category is what I call dual-role relationship by proxy. It happens this way: The candidate may be caught in sibling rivaIries that can exist between analysts. Sometimes analysts are jealous of each other, enter into power struggles, or come from mutually distrustful schools of thought. A training candidate may become associated with an analyst, perhaps by being in analysis, supervision or by being interested in the analyst's writings. If the associated analyst is the target of resentment from other analysts, the candidate may become the recipient of the resentment. When this happens, the candidate may not be accurately evaluated in training. For example, a candidate may find themselves being questioned about their "developmental approach", their "Zurich attitude," their "lack of transference analysis" or some such, when the supposed problem really is related to doubts about the candidate's analyst or supervisor and may represent an inaccurate evaluation of the actual candidate. This would be an example of a problematic dual-role relationship by proxy.
What shall we do? The pessimist and the optimist within me struggle for dominance. The pessimist cries out that dual-role relationships within an analytic society are ubiquitous, intractable, unavoidable, problematic and therefore our training program and all of us within it are doomed! The optimist says, gee, these dual-role relationships really are a wonderful opportunity to leam about transference, ethics, human nature, our colleagues and ourselves.
One thing we should not do is ignore our problems. Too often I have seen us mutter to ourselves or whisper to each other about the "incestuous training relationship" of analyst x and candidate y, while nothing is said openly and nothing is done. Such a pattern of misgivings, mistrust and secrecy poisons the container of a society's training program. It resembles the pattern of deception seen in families where incest is a never acknowledged secret known by all.
I have heard the opinion expressed that we do not need rules, boundaries, or ethics codes. Such procedures might inhibit the spontaneous flow of soul and psyche as we relate to each other. After all, when we are sensitive to the primary responsibility of training and the feelings of each other and of our colleagues, problems don't occur. I don't agree with this "have no rules" opinion. After five years serving on my county medical society committee for impaired physicians and six years serving on an analytic society's Ethics Committee, know that we need enforceable rules. Unfortunately some of our colleagues suffer from feelings of speciaIness and entitlement where they consider themselves so important, so gifted, that the usual standards of conduct should not apply to them. Some of our colleagues rationalize their own desires for adoring disciples or for erotic closeness as being really in the best interests of the candidates they have selected. Unfortunately, some of our colleagues behave like predators. Due to the power differential between analyst and candidate in training, it is often difficult for the candidate to say "no" to the overtures of a predatory analyst. So we need to know what to do.
Our first step is to remind ourselves of who we are and how we should relate to each other. Every few years we need a conference like this to do some consciousness raising. Unfortunately it is a bit like "preaching to the choir". Those who understand our concerns probably already manage dual-role relationships well. Those with problems either will not listen or will acknowledge how the issue applies to others, while imagining that they are exempt, special, and not to be questioned.
As another step I suggest that we add one sentence to our Ethics Code. At present, most codes have a section on Collegial Relationships which reads something like: "Professional relationships shall not be exploited by members. They do not, for example, accept payment from other professionals for referrals." I suggest that we add the following: "Aware of their own needs and of their influential position vis-a-vis candidates in training, analysts shall make every reasonable effort to avoid dual relationships that could interfere with the candidate's training."
Another step is to make explicit what to do if analysts become concerned about a dual-role relationship in a training program. As a rule of thumb I suggest that if anyone is concerned about such a relationship, the analyst involved should be recused from evaluating the candidate involved. When I say "anyone," I mean the candidate, other candidates, other analysts, anyone. There will always be plenty of substitutes to replace the involved analyst. The involved analyst may not see any problem, and the involved candidate may be feeling good about feeling special and so not see any problem. That is why it is important for someone outside the "special relationship" to speak up.
First the involved analyst should be asked to recuse him or herself. If the analyst balks, analysts at the local training level should insist. Or the Review Committee should be informed and its analysts should ask that the involved analyst be recused. If the involved analyst is on the Review Committee, the request would go to the Training Committee which oversees the Review Committee. If the involved analyst continues to insist on the "special relationship" and to insist on training the candidate, members of the Executive Committee or the Ethics Committee should be asked to intervene. Members of the Executive and Ethics Committees have seen these problems before and know how to explain what is required to remain a training analyst in good standing.
What it the complaint of dual-role relationship is mistaken, perhaps due to some complex of the person objecting? Then the candidate or the involved analyst could go before the candidate's Review Committee and explain why they see no problem in working together. Due to the power differential between training analyst and candidate, I don't think a candidate should have to prove that a dual-rote relationship exists. Rather, should a complaint occur, the burden of proof should be on the most powerful member of the dyed, the involved analyst, to disprove the assertion.
In summary, we need a sharing between candidates and analysts which is intimate and which respects their roles as candidates and analysts. I suggest that we periodically reflect about dual-role relationships in training. I suggest also that we respect the opinions of candidates or analysts concerned about dual-roles, and that we provide clear and safe pathways for candidates to reject unwanted overtures from analysts.
When I served on my society's Ethics Committee, the members continually hoped we would have nothing to do. Intervening with colleagues who transgress boundaries is painful for all concerned. It is so much more pleasant to be spontaneous, trusting, focused upon matters of soul and spirit! Nevertheless, as professionals with responsibilities towards our training program, we do need to attend to our organizational shadow. The hope is to contribute to a training container secure for all involved.
Copyright 1996 Joseph Wakefield. All rights reserved.
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