In his introduction to the booklet of the Istituto Freudiano, the Insitute that interfaces our School, the SLP, with the current law, Jacques-Alain Miller describes the Italian law aimed to regulate psychotherapy as illuminée, that is: inspired by the spirit of Enlightment.
When we read this definition, at the time, we thought that maybe there was a little captatio benevolentiae in this expression: Miller was making a public statement, we had made the decision to adjust ourselves to the new legal situation, and of course the law couldn’t be publicly criticized. We all thought in fact that the law would create difficulties, restricting the practice of psychoanalysis to physicians and to psychologists, and imposing a bureaucratic machine to psychoanalytical training.
Psychoterapy in Italy is regulated by a law passed on february 18, 1989, Act n° 56, colloquially called the Ossicini law, by the name of its main promoter.
Mr. Ossicini is a politician, an elected senator in the Italian Parliament, who was, at the same time, a catholic, a communist, and a psychoanalyst. You might think this is a weird hotchpotch, and it is. But while being catholic and communist was normal in Italy at the time – what we called the cattocomunisti, which is not an insult, but neither a compliment – it was less common to be a catholic and a psychoanalyst, or a communist and a psychoanalyst.
So we can say that the Italian law for psychotherapies comes from a strange mix, where political and moral interests are concocted in a bizarre way with various kinds of psychotherapies. There was in fact a long debate before its promulgation, that lasted almost twenty years, and during which it was the medical corporation to deny the green light. Before the enactment of the law, any therapeutical act, including a psychotherapeutical one, was allowed only to physicians. Anyone who practiced psychoanalysis, if he or she wasn’t a doctor, was at risk of being cited for malpractice.
Thus, the first positive effect of the law, by creating a Psychological Association, was to put the Psychological Association and the Medical Association on the same level. The therapeutic act was no longer an exclusive prerogative of the physician.
The creation of the Psychological Association implies a definition of what psychological practice is, and the law has a special item for defining, as a special case of the psychological profession, what is psychotherapy is.
The item is n° 35 of the Act. It states that psychotherapeutical practice is allowed to all who are registred in the Psychological Association or in the Medical Association, and who solemnly declare to having completed all the necessary professional training in psychotherapy, providing relevant certification, indicating the place, period and length of training.
As you can see, there are no rigid standards to define what a psychotherapist is: a psychotherapist is, in fact, anyone who has been trained in an acknowledged School, and there is no strict criterion to which a psychotherapist has to conform in order to be so defined under the law: anyone who completes his training in a School in line with his sensibility meets the requirements. The only constraint is providing documentation of the training.
This is the second positive effect of the law: the legislator doesn’t show a will to control the doctrinal grounds and the real practice of psychotherapy. He is not a draconian lawmaker, he just wants to be sure that a psychotherapist has actually done the training, whatever it is, and doesn’t meddle in a matter of theorical evaluation: whatever works. So it was, at least, in the beginning. The University Ministerial Board eventually charged to examine the suitability of the Schools to be legally recognised has in fact, to the current date, authorized 338 Schools. As every School can admit 20 students a year, we have a total of more than 6700 graduate psychotherapists per year. This means a huge amount of trained psychotherapists on the market. It has been calculated that there are now 37000. It is the hightest percentage in Europe. This has persuaded the Ministerial Board to grant a moratorium on the acknowledgment of the Schools, and to pass from a technical-bureaucratical procedure of admission, to a more evaluational one, involving criterions, quality requirements and control of didactics.
The training system in Italy is provided both by private Schools – that, as we have seen, with some restrictions are however free to organise their courses – and by public Schools, created by Universities, that usually are prone not to follow a specific psychotherapeutic tendency, and that try to reflect, in an apparent neutral way, the whole panorama of psychotherapies. Actually, psychology departments in universities are thoroughly dominated by scientism and by cognitive-behavioural models, and of course they influence the trend of specialization in post-universitary courses.
You will wonder: where do we find psychoanalysis in all this scenario? You are right, we don’t, and this has been a precise choice. In a first draft of the law psychoanalysis was mentioned among all other psychotherapies, but the SPI, the Italian representative of the IPA, put pressure on the legislator to remove the reference, and because the SPI was a powerful institution, the legislator took heed, and psychoanalysis was excluded from the final text of law.
This fact created a lot of controversial debate. How should this silence on psychoanalysis be interpreted? Two opposite school of thought arose, and debate was intense. The first believed it was obvious that psychoanalysis wasn’t regulated by the law, because it wasn’t named, and it follows, the only reason for this was that psychoanalysis, whatever it is, is not psychotherapy, it is not aimed to heal a symptom, and if you get any relief from it, it’s just a collateral benefit. The second thought it was obvious that psychoanalysis was a psychotherapy, and if the law doesn’t mention it, it is because there is no need: what else should psychoanalysis be, if not psychotherapy? Why should someone pay for a long and expensive treatment if not to be relieved from his disorders? If the problem is to know yourself, they said, you’d better consult the Delphic Oracle, and so on.
In this heated debate a famous jurist, Francesco Galgano, professor of Commercial and Civil Law, and a consultant to the Ministry of Justice in the 1980’s, expressed a parere pro veritate, often quoted in the discussions of this topic(1). This parere claimed, merely on a legal basis, there was a distinction between psychoanalysis and psychotherapy. But a parere pro veritate is just a point of view, even if stated by a public and prestigious figure such as Galgano. The issue had to be decided in the coming years by sentences pronounced by judges. And we can now say that it has been decided. All the lawsuits that have been brought against psychoanalysts for malpractice have been lost by the plaintiffs, and the psychoanalysts have always been acquitted. This could seem to be a good thing for psychoanalysis: we feel neither under the threat of the law, nor its limitations. But we need to pay attention, we need to read the motivations behind the judgements. In one of this trials, the psychoanalist was acquitted because his patients – but we can’t call them patients, because it isn’t psychotherapy – so his clients testified that the defendant just asked them to make some free associations, he never prescribed them drugs, he never suggested them particular behaviours, or performed psychological tests. In another trial the judge, after having listened to the defense, ruled to acquit the defendant because he didn’t give any indication to his client on the behaviours to adopt in society in reference to the different situations he had to face, and he limited himself to just listening to him, without intervening; he just offered a passive support to someone who merely needed to know himself better. In a further trial the judge acquitted the defendant claiming that the psychoanalyst didn’t do anything active, but rather just took a passive position and listened someone speaking of his joys and pains, and thus resulting in no damage.
So we, the psychoanalysts, can practice in Italy without having to worry about the law, without needing to have any academic training as psychologists or as physicians, and having neither the restrictions nor the protection of the law. We can do that, and if we are responsible, we needn’t worry, because our practice isn’t dangerous, it does no harm, and if it’s harmless it’s generally because it doesn’t do anything. The psychoanalyst is a passive listener, and the maximum of what he can do is play with words. The State need fear no such character!
So I think we made a good choice when, with Miller, we decided to work within the law, and we decided to create an acknowledged Institute to manage the interface with psychotherapy. We wanted to preserve psychoanalysis, its traditions, its culture, its specific training, and above all the lacanian way of training, and this had to be the purpose of the School, but we didnt’t want psychoanalysis to be thoroughly separated from psychotherapy, and because in psychotherapy we had to abide by the law, we created the Institute whose mission was to train psychotherapists in the lacanian way.
So we can say: psychoanalysis doesn’t exist in Italy, according to the law, if psychoanalysis is a practice aimed at treating a symptom. If you want to treat a symptom you have to be a psychotherapist, and this is the only legal title allowing you to provide therapeutic effects for the menthal healt of someone, except if you are a psychiatrist, but in this case you usually limit yourself to prescribing medications.
I think that in Europe we now have to engage in a battle of civilization, because wiping out psychoanalysis is not just erasing a practice, but also destroying a culture, a way of life and a way of escape from the scientism which current administrations are forcing upon us, desubjectiving us, treating health as a commodity, something business-like in terms of efficiency, productivity and profit.
In UK this issue is only too familiar, more than in any other european country, because of Mr. Richard Layard, a professor of ecomomics who really has the happiness of the people at heart, and whose idea is that the ultimate aim of public policy is to make people happier, and as mental illness is the greatest threat to a happy life, he has engaged himself in a campaign to provide within the NHS evidence-based psychological therapy for people with clinical depression and chronic anxiety disorder (2). This will come to Italy too, maybe, but UK is at the avant-garde, at the forefront, or rather at the vanguard.
In Italy, until now, we had developed the capacity to face the threat coming from University, where there is no psychoanalysis, where there is the negation of psychoanalysis. But other forces are now rising against us, coming from the coalition of psychiatry and pseudo-scientific psychoterapies. An attempt is being made, for instance, to enrol psychotherapy in a health insurance fund. Psychotherapies could be paid by the public health service, and the risk of this, of course, is that all paid psychotherapies would be standardised and evaluated using an evidence-based criterion. If the bureaucracy of the administrations will be the catalyst to combine the pressure put on us by the University on the one hand, that is always trying to steal training from private Schools, and by psychiatry on the other hand, trying to invalidate a non evidence-based treatment, then we will have to face a very hard fight to put this matter right.