A Candidate’s Experience Doing Research During Training

Analytic Listening / Textual Analysis

For the past four years the three of us have pored over transcript after transcript. We spent hours upon hours reading the texts line by line. Initially, we read them for the first time and discussed them together. Later we read them separately and then convened to reread them to one another. If it sounds like an almost Talmudic-like process, it felt like it. This process was similar to the experience of sitting in process class and reading aloud my clinical material with my patients or listening to my classmates or recent graduates read theirs. The interview transcripts have varied in length: some long, some relatively short. They have also varied in depth: some remarkably engaging and informative, insightful, and self-reflective, others surprisingly guarded, somewhat superficial, and even perfunctory. This is not so different from how treatment sessions may vary from time to time. Much of this was determined, of course, by the analyst-interviewee’s attitude toward the interview and the level of self-reflection he or she was capable of and willing to engage in with the interviewer on the questions. Another factor was probably some contribution of the “relationship” between the two of them: the rapport and chemistry, the level of comfort and safety to talk openly and delve more deeply. I found myself sometimes reading a transcript and wondering if this could be a patient speaking directly to me in a session, or, alternatively, in a session listening to an analysand’s narrative and wondering if I could be reading this as an interview “text.” This helped me think more about how similar or different the interviews and actual analytic sessions are and how “close” I could feel to material in a session versus how “distant” I might be from it, like one step removed in reading a text or hearing process material.

These dynamics clearly paralleled for me some of the intrapsychic and intersubjective dynamic processes my classmates and I were learning to pay attention to, listen for, and wonder about. However, in our research group it was not our task to “interpret” the material. The purpose of the research has not been to “analyze” the study participants but rather to understand and agree on what they are telling us. We have tried to stay very close to the manifest content, so to speak, in order to know only what the analyst-participants are conscious of and to develop a methodology for saying something meaningful about these data. For this type of study we do not make inferences about unconscious dynamics such as conflicts, defenses, fantasies, or characterological styles. We do not try to interpret the interviewee’s “transference” to the interviewer or any other person he or she is speaking about (e.g., teachers, supervisors, training analysts). Nor do we interpret “resistance” to the interview or any topic regarding training or post-training the interviewee is discussing or possibly avoiding. While we may think together about such dynamics from time to time—as analysts are trained to do every clinical hour—we resolved that not only is this not the point of the study, but that it would probably be impossible, at this stage in the field’s developing research methodology, to determine these dynamics on any reliable basis. One need only be reminded of the study by Vaughan et al. (1997) in which senior training and supervising analysts could not agree in a statistically reliable manner on the presence of analytic process.

The Problem with Affect

Interestingly, even staying so close to the “surface” proved extremely challenging. As we were developing the codebook we would use to rate the interviews, one of our early codes related to affect. We felt it important to try to ascertain the quality and intensity of affective feeling with which the interviewees talked about particular subjective experiences. Clearly, listening for affect is fundamental in analytic work. Even more difficult is understanding our patients when one affect may be defending against a deeper, more troublesome one. However, despite repeated attempts, we could not reliably code the participants’ manifest affect, even on a simple scale for positive, negative, or ambivalent feelings. Ultimately, we had to leave the affect coding out of the statistical tabulations, where first we coded independently and then reached agreement. Instead we left considerations of affect for the meetings in which we read text as a group and tried to reach consensus. This outcome had a profound impact on my felt security in listening to patients and participating in process class discussions: it tested my confidence in always feeling sure of what I was hearing and understanding, taught me not to jump too quickly to conclusions based on limited data, and helped me remain open to other ways of “knowing” the feelings in my own patients, in my peers presenting in class, or in myself. It was around this time, as our research team struggled with the issue of coding affect in the interviews, that I was exposed in one of my theory classes to Bion’s application (1970) of Keats’s notion of “negative capability.” Learning about the ability to tolerate uncertainty and “not knowing”—whether not being able to identify affect data in the interviews or, in clinical work, not understanding the patient at any point—marked an important moment for me: the research and the didactic-clinical aspects of my training had synergistically come together.

Training Analysis

I remember a number of instances in which my associations during my analytic sessions referred to some of the responses given by interviewees in our research study. For example, during a time around the middle of my training when my analyst and I were exploring a particular transference issue, I recalled some of the interviews in which the interviewees reflected back on their training experiences and mentioned various issues in their own training analyses. Some of these experiences were similar to my experience in analysis and some were, perhaps more interestingly, quite different. This made me wonder aloud in session how I would feel if my own analyst had interacted with me or interpreted to me in ways similar to or different from how the interviewees described their experience. While it could be argued that exposure to these revelations from others’ analyses could be used as a resistance in a candidate’s treatment, I believe that in my case it helped deepen the transference manifestations my analyst and I were working on and helped me better clarify my understanding of the transference wishes I was expressing and how my analyst was responding to them. Thus, in these instances, I found my knowledge of other candidates’ experience could be used as grist for my own mill. A risk that I can see, as a candidate, in reading about treatment examples as discussed by participants in the study is the impact of being privy to the private transactions in other training analyses. It seems to me, as with most things, that the important factor in these cases was how I used this knowledge gained in the research task to further my self- exploration by bringing it into my treatment for analytic investigation instead of defensively keeping it out or splitting my research and personal analytic experience into separate areas within my mind and not linking them for greater psychic integration. I acknowledge that it has been a frequent challenge for me to consciously decide, or freely wander to, what specific research material was stirring in me and was important to bring up in my sessions.

There have been numerous other interesting responses from interviewees about their training analysis experience: some overwhelmingly positive, some generally positive, some quite ambivalent. All of these have made me think not only about how I have been experiencing my own analysis (or even in “positive,” “negative,” or “ambivalent” terms) but also how I would reflect back on my analytic experience years after terminating. Many of the responses have led me to understand better how analysis is never really over—that these graduates are still working over aspects of it in their minds, integrating it, modifying it over time, and that their working through is ongoing (Freud 1937). In some responses I have discerned certain transferences appearing still to be quite intense, or to be lessening. It has made me wonder if the transferences were in a process of “resolving,” if such a thing happens, or instead were persisting in some form (Gabbard 2009). This would have important implications for my own experience of transference as I explored it in my analysis along with the eventuality of termination in the future. I have tried to be mindful of how learning about graduates’ analytic experience in retrospect could “prime” me for, or even potentially “preempt” me from, having a spontaneous affective experience of my own in analysis, and how I could use this defensively in my personal work.

Supervision

Supervision is another area in which I have been privy to graduates’ experiences that have paralleled my own or been markedly different. For example, supervision experiences so negative that the interviewee requested a change during candidacy was far from my own experience. A couple of interviewees have spoken of a poor “match” between themselves and their supervisors because of disparate theoretical views and technical disagreements in how to work with their patients. Some interviewees who were having a bad supervision experience discussed how anxious they were in requesting a change; they worried how this would look, that is, how it would be “interpreted” by their progression advisors and others. Although I believe my institute does a very good job reassuring candidates that making such a request, or simply seeking a discussion about it, does not reflect poorly on the candidate, who will not be “pathologized,” this is a real fear among candidates. The issue of poor supervision “matches” and what to do about them has come up in our candidate organization meetings, though it is not talked about as openly as it has been in the interviews. Reading about these interviews has opened my eyes to the range of supervision experiences among candidates. It has made me think how fortunate I have been in feeling comfortable with my supervisors, despite occasional theoretical or technical differences; only a terrible “mismatch” would make me consider a change of supervisors. However, I could imagine myself in such a situation feeling the anxiety and insecurity felt by the interviewees who ultimately did make a change.

Control Cases

Reading about analysts’ experiences with their control cases has been extremely informative and also reassuring. Interviewees have been quite open and reflective about the struggles and pleasures of having been a candidate trying to get analytic cases going and learning how to practice analysis. This has directly mirrored some of my own experience. For example, when interviewees talked about how thrilled and nervous they were to get their first cases going, I can remember my own excitement and anxiety when my first case was approved and got under way. Similarly, when other interviewees discussed how difficult it was when their cases dropped out early in the treatment, I could relate to the disappointment those candidates felt because I too had had a case drop out early. I could also identify with the interviewees’ questioning of their competence and skills in losing a case and the anxieties they felt around what their supervisors and advisors would think about it. Like the interviewees, I felt relatively secure in my clinical skills and had been practicing psychotherapy a number of years before starting analytic training. However, conducting an analysis is a very different and unique enterprise, and losing a case, for whatever reason, can be a blow to one’s self-esteem and perhaps even an embarrassment around one’s peers and superiors. This should not necessarily be the case. But I felt reassured and less self-critical after having read repeatedly in the interviews how many times candidates had lost cases. In fact, research conducted at the Columbia Center (Hamilton, Wininger, and Roose 2009) has documented that 40% of patients dropped out within the first twelve months of treatment. Strangely enough, it was comforting to know that my experience was part of that statistic and not necessarily a reflection on my skills.

This case served a useful educational purpose for me because I presented it in one of my process classes just as the patient was struggling with the treatment toward what would soon be its end. As it turned out, the patient “suspended” her analysis before the last couple of sessions of the class. I felt like I was presenting a case “in crisis,” and it was being discussed by my classmates and instructors in “real time.” I am not sure I would have had the courage to present such a case without the support and encouragement of my instructors, but I was strengthened also by the knowledge I had gleaned of my predecessors’ similar experiences with “lost cases.” A potentially embarrassing situation for a new candidate became instead an opportunity for learning, growth, and an alleviation of my harsh self-criticism and sense of shame. Ironically, some time later, in another process class, a senior training analyst joked, “You’re not an analyst until you’ve lost your first case.”

Institute Life and Beyond

Many participants in the study have talked about their experiences within the institute’s structure and culture. In reading these narratives I have often felt that I was reading something about myself. References to dynamics between classmates, relationships between candidates and faculty and supervisors, evaluations of the curriculum and committees—all have run the gamut of positive and negative feelings, appreciation and regret. When interviewees have spoken about how they disliked the “politics” within the institute, even without their specifying what they were, I could not help wondering if anything has changed since their time and mine. Many of the problems seem to exist in perpetuity. I have frequently sat in candidate meetings where my classmates have raised issues I had recently read about in the interviews and coded with my co-researchers. There appear to be experiences, almost “universal,” that most candidates undergo as part of the nature of training and the structure of institutes. Competition, envy, insecurity, exclusion, ambition, regression, infantilization, idealization—the mix of feelings and dynamics may be particularly intense in analytic training, rather like “family life” (Kernberg 1986).

However, there are frequent complaints I have discovered both in the interviews of graduate analysts and in my firsthand experience in life among my classmates. These concern, first, the “battles” waged between theoretical schools of thought within the field, which have a divisive rather than constructive effect, and, second, the policy fights among the administrators of our governing bodies and associations. Just as our study participants have described how these situations contribute to their reluctance to share their opinions, expose their work more, or get involved at local or national levels and instead remain within the safe confines of their offices, classrooms, or selected committees, so too my classmates and I have often voiced our displeasure with these conflicts, which I have heard called “acrimonious.”

A theme that has emerged in many of the interviews is the realization, which should come as no surprise, that our field is often not a big, happy family where everyone gets along; rather, junior analysts often prefer not to get involved in settings where the “grownups” are fighting. It has distressed me to see this reality more clearly by learning about my senior colleagues’ views through the research project. Candidates may be protected somewhat from the politics and disagreements at the higher levels of their institutes, but I have been afforded a window into some of it by witnessing in the interviews the experiences my predecessors have had in transitioning from candidates to faculty members. I hope this has allowed me to develop a more reality-based perception of my institute and the field in general, as opposed to holding on to certain Pollyannaish or “infantile” idealizations. However, perhaps some of the “fantasies” I might have had about institute life and the postgraduate experience have been short-circuited by this injection of reality, and therefore are not as available for my analytic exploration. I sometimes wonder if the perspective I have from these interviews has served a defensive purpose for me. I feel this is still in process for me.

On another personal note, many interviewees have talked about their struggles to balance their training and post-training professional lives with their family and private lives. These stories, told repeatedly, have become a major theme in our coding and analysis. An ongoing theme in the follow-up interviews is how analysts negotiate the conflicting demands they feel in work and family life, as well as societal constraints such as lack of insurance reimbursement for practicing analysis. Many have said they wish they could practice more analysis but have difficulty getting new cases or cannot take more time away from their children and home lives. Many express deep concern about the viability of analysis in this age of managed care, psychopharmacology, and short-term treatments. This is the work environment my classmates and I are entering. The fears and anxieties explored by the analysts in the study are awaiting my cohort as well. On the one hand, I would honestly say that reading and discussing the interviews has made me more alert and sensitive to these practical realities and allowed me to start thinking and preparing for them sooner than I would have otherwise. On the other hand, being exposed to these first-hand accounts has intensified some of my anxieties about the viability of analytic practice.

Process Classes

As I have intimated, my experience in process classes has been deepened by my participation in research. However, certain challenges also come to mind. In class, process material is read aloud to the group. We sit there and listen (or read our own material). In some classes we may try to listen to the patient with evenly hovering attention, in others with reverie; we may discuss what it means to listen without memory or desire. We cross theoretical domains and technical recommendations. In classes with specific pedagogical goals, we may listen for free association, transference, resistance, affect, or defense, or we may pay attention to our countertransference. One could think of all of these as “themes.” In our research project, we read interviews either alone or together as a group and, using the methodology of grounded theory, attempt to discern the themes that emerge from the interviewees’ verbalizations in interaction with the interviewer. It seems to me that particular analytic listening skills, not to mention understanding or interpretive skills, can be strengthened and developed more fully by greater engagement in process and more “variegated” process. I consider the shift from “listening” or “thinking” in a clinical mode or a research mode as a generally complementary experience, perhaps akin to artists working in a “mixed media” format in which they use different materials to inform, challenge, and complement each other. As described earlier, our overall project is a “mixed methods” design, in that it includes both quantitative and qualitative approaches. This type of design has increasingly achieved acceptance as an appropriate methodology for psychoanalytic research (Tillman, Clemence, and Stevens 2011). Similarly, the interplay of clinical training (candidacy) and research training can serve to strengthen one’s analyzing function or “instrument” (Isakower 1992) as more skills are learned and integrated. I can see how going from a research meeting to a process class, or vice versa, which I have often done, has frequently facilitated a more complex and ultimately enriching analytic experience for me as my listening and thinking modes have shifted or “jelled” in a more seamless way.

However, at certain other times I have wondered if the shift highlights a difference in the listening agendas between clinical process and research process. For example, in our project we highlight passages of interview material to code for particular themes (as we tried to do for affect), and if we code for one thing at a particular point it may mean we are not coding for something else. This may be true for clinical work as well, where making an interpretation about one thing means not interpreting something else that may also be there. Nevertheless, in the research we were listening to the material in order to close things down on a code at that data point. By contrast, in process class we listen to material and the instructor may ask us, “What are you hearing?” We may come up with different reactions to the material: someone may be struck by the patient’s affect; another by a defensive maneuver; still another by an unconscious fantasy. We do not need to reach consensus on the essential theme; we may try to hold all possibilities (or hypotheses about what is going on with the patient) in mind at once for the time being. In this way, we are listening in order to open things up in the mind of the analyst. We may not understand the patient’s material until it is elaborated in later associations, or even sessions. Thus, in clinical analytic work we may be continually revising and modifying our hypotheses and interpretations (Waelder 1936), as opposed to codifying data at given moments in research. I think this distinction in listening agendas is an important one for those who work in both clinical and research modalities. For me, I have found that listening in the research mode has made me aware of potentially having to close off options, but it also has sharpened what I believe I am hearing. Alternatively, listening in the clinical mode has allowed me to keep options open, but also question what I think is most salient in what I am hearing.

Research Group Process and Internal Process

I wish to discuss briefly a specific piece of data from our study. While illuminating our research group process and highlighting a tension in me in integrating research with the training experience, it also demonstrates how I tried to work the data into my own psychology. One afternoon, my two colleagues and I, deep in the research hour, read an interview transcript. It was a baseline interview, so it was the first interview since the analyst had graduated from training the previous year. He (for simplicity, I will use the masculine pronoun to refer to the interviewee, whose gender was not identified in the transcript) was responding to questions about whether he was interested in being certified and eventually applying for appointment as a training and supervising analyst. At one point the analyst made a slip of the tongue, using the phrase “jelling in my screw.” We all looked at each other and laughed. It felt like a spontaneous and transformative moment in our group process. I experienced it as similar to moments in treatment when something feels loosened up, like a defense, or a new affect is expressed, in a patient or in myself. We thought the slip was quite funny and informative, but unfortunately could not code it because we needed to remain on the conscious and manifest level of the text. There was, of course, something lovely about the slip, which the analyst recognized immediately in a seemingly self-effacing way, and it left us pondering what he meant. But it was not our research task to explore or interpret it, which, as analysts, we might a piece of clinical material with a patient. In our effort to be “empirical,” we can lose aspects of the subjectivity of the individual because we cannot explore the deeper meaning of his unconscious production (Kächele et al. 2009). This was disappointing, of course, because of how analytic training nurtures a curiosity and desire to understand things at a deeper level. For our research purposes, however, we had to stop there.

All of us could associate to what seemed a beautiful condensation of several ideas and feelings in this interviewee, which related to the issue of certification and training and supervising analyst status. In our off-the-record discussion we wondered if he meant “jelling in my mind,” which would serve for me a fitting characterization of how my clinical, personal, and research analytic experiences are taking shape in my own mind as I progress through training.

However, in thinking further about the slip, I could also identify my own anxiety that after all the hard and long work of completing analytic training, I would then have to face thinking about certification and possibly pursuing training analyst status. A number of interviewees have referred to all the “hoops” that have to be jumped through, even after actually becoming a bona fide analyst. All this made me struggle with not knowing how I would feel about this once I graduate and start contemplating further professional growth and challenges. Yet that moment of “experiencing” the interviewee’s slip with my more senior colleagues felt containing for me, as though I were being “held” during my present developmental stage by my parental figures in our group process.

As it turned out, when the same analyst was interviewed for the third time, four years later, we read that he was reviewing some of his cases for certification. Clearly there is a developmental process at work here, some kind of “jelling” from the first to the third interview. Some of the most compelling interviews I have read over the years in the study have been those in which the analysts—candidates like me once—have overcome ambivalence and fear, resolved personal conflict evident in their evolving narratives over time, and arrived at more comfortable and satisfying positions in their careers and their relationship with analytic work, whether they maintain analytic immersion, run clinics, teach, supervise, write, conduct research, or some combination.