The Problems and Contradictions Inherent in Analytic Training and the Ultimate Requirement: Working with Uncertainty


In this essay, the author’s aim is to outline the specifics of psychoanalytic intervention and its current relevance. She explores the boundaries of the clinician’s identity, (whether psychotherapist or psychoanalyst), examines the training itself, as well as how and where one can develop the skills necessary to engage in this profession. She specifically assesses the Italian situation. For the construction of the identity of the therapist/psychoanalyst it is fundamental to learn how to tolerate uncertainty, seen here as a value, not a limitation, in contrast with the certainties which characterize other forms of psychotherapy. The complexity of psychoanalytic training is thus demonstrated as a function of two particularities, that of methodological rigor, incorporating all the necessary theoretical knowledge, and the delicate skill of being able to maneuver within the world of passion, regulated by the personal identity of the clinician.

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  1. Buber, M. (1947). Between man and man. R. Gregor-Smith (Trans.). London: Routledge. 2002.

  2. Drescher, J. (2008). A history of homosexuality and organized psychoanalysis. Journal of the American Academy of Psychoanalysis, 36, 443–460.

    Article  Google Scholar 

  3. Ephron, H. S., Horney, K., Kelman, S. R., Robbins, B. S., & Thompson, C. (1941). Explanatory note. American Journal of Psychoanalysis, 1, 9–10.

    Article  Google Scholar 

  4. Ferrini, R. (1996). The qualities of the analyst. American Journal of Psychoanalysis, 56, 161–165.

    Article  Google Scholar 

  5. Freud, S. (1913). On beginning the treatment, Standard Edition (Vol. 12, pp. 123–144). London: Hogarth.

    Google Scholar 

  6. Fromm, E. (1964). The hearth of man: Its genius for good and evil. New York: Harper & Row.

    Google Scholar 

  7. Fromm, E. (1973). The anatomy of human destructiveness. New York: Holt, Rinehart & Winston.

    Google Scholar 

  8. Galli, P. F. (1986). Psicoterapia, psicoanalisi e psichiatria nei primi anni 1960. Appunti per una storia. Articolo apparso nella rubrica “Minute” della rivista Il Piccolo Hans, 1986, 50 (aprile-giugno): 173–190 (Bari: Dedalo) e su Psicoterapia e Scienze Umane, 2011, XLV, 1: 75–88. [Psychotherapy, psychoanalysis and psychiatry in the early 60s. Notes for a story. Article published in the column “Minute” of Il piccolo Hans Journal, 1986, 50 (April–June): 173–190 (Bari: Dedalo), and republished in Psicoterapia e Scienze Umane, 2011, XLV, 1: 75–88].

  9. Garza-Guerrero, C. (2004). Response. International Journal of Psychoanalysis, 85(1), 18–25.

    Article  Google Scholar 

  10. Garza-Guerrero, C., & Laufer, E. (2004). Reorganizational and educational demands of psychoanalytic training today: Our long and miasmic night of one century. International Journal of Psychoanalysis, 85(1), 3–13.

    Article  Google Scholar 

  11. Godley, W. (2001, Feb. 22). Saving Masud Khan. London Review of Books, 23(4). New York: NYREV, Inc.

  12. Green, M. (1964). Letter to the Members of The American Psychoanalytic Association, 1941. In Vita di Clara Thompson [The life of Clara Thompson], by M. Green. In C. Thompson (1964), Psicoanalisi Interpersonale, Boringhieri, 1972, (pp. 445–480).

  13. Kelman, H. (1959). Communing and relating: Part III—examples: General and clinical. American Journal of Psychoanalysis, 19, 73–105.

    Article  Google Scholar 

  14. Kernberg, O. F. (2011). Psychoanalysis and the university: A difficult relationship. International Journal of Psychoanalysis, 92(3), 609–622.

    Article  Google Scholar 

  15. Kohon, G. (1999). No lost certainties to be recovered. London: Karnac Books.

    Google Scholar 

  16. Laufer, E. (2004). Rejoinder: With reference also to Garza-Guerrero (2002). International Journal of Psychoanalysis, 85(1), 13–18.

    PubMed  Google Scholar 

  17. Morin, E. (1984). La sfida della complessità [The challenge of complexity]. M. Ceruti & G. Bocchi (Eds.) Milan: Feltrinelli.

  18. Sandler, A. M., & Godley, W. (2004). Institutional responses to boundary violations: The case of Masud Khan. International Journal of Psychoanalysis, 85(1), 27–42.

    Article  Google Scholar 

  19. Thompson, C. M. (1958). A study of the emotional climate of psychoanalytic institutes. Psychiatry, 21(1), 45–51.

    Article  PubMed  Google Scholar 

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I would like to acknowledge the support of Dr. Ian Miller, who invited me to contribute to this Special Issue and extend my gratitude to Prof. Pier Francesco Galli (1986), with whom I discussed this topic several years ago.

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Correspondence to Anna Maria Loiacono.

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Anna Maria Loiacono, Ph.D., President, “H.S. Sullivan” Institute of Florence; Faculty, Training and Supervising Analyst, Institute of Analytic Psychotherapy of Florence; Relational/Interpersonal Psychotherapist and Psychoanalyst in Florence, Italy.

Address correspondence to Dott. Anna Maria Loiacono, Via GiambattistaVico, 13, 50136 Firenze, Italy. Email:; Website:

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Loiacono, A.M. The Problems and Contradictions Inherent in Analytic Training and the Ultimate Requirement: Working with Uncertainty. Am J Psychoanal 81, 51–59 (2021).

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  • psychoanalytic training
  • identity
  • uncertainty
  • passion
  • narcissistic injuries