Abstract
A new model of psychoanalytic education is proposed that will meet the challenges of educating candidates in a new century. Prospective candidates have varying opinions about the value of analytic training, opinions that reflect economic and cultural conditions different from those facing previous generations. Overall, today’s graduate-level students hold less favorable attitudes toward psychoanalysis than did their counterparts in the past. The proposed model calls for combining analytic candidates, psychotherapy students, and academic scholars for two years in a Psychoanalytic Studies Program (PSP), after which candidates take their subsequent years of training in a cohort made up exclusively of analytic candidates. A curriculum that focuses on the core concepts in psychoanalysis allows students in all three categories to learn the foundational knowledge of psychoanalysis that once was widely taught in graduate mental health programs. The philosophy that underlies the model and the structure and orientation of the course sequences are presented. Implementatiion of the model having shown positive results, its strengths and limitations are evaluated against the traditional model, in which candidates and psychotherapy students are educated separately.
Keywords
Psychoanalytic institutes need a new model for delivering psychoanalytic education. In 1992 James Morris declared that “psychoanalytic training is alive and well” (p. 1207). A decade later, the view was not so rosy. A new century found many institutes with aging memberships, fewer candidates, and a national organization that was embroiled in a destructive internecine conflict over the training analyst system. The future of APsaA-based training was looking bleak indeed.
Over the past several years, the training analyst issue has been at least partly resolved. But the relative lack of students to train remains devastating. For a number of years our organization, the Washington Baltimore Psychoanalytic Institute, had been unable, like many other institutes, to recruit enough candidates to be able to offer classes. And so, again like other institutes, we awkwardly devised compromise training situations, with at best middling effectiveness.
In 2005, a well-attended discussion group at an ApsaA meeting, led by Erik Gann, “On Being and Becoming an Analyst in the Twenty-First Century,” addressed the value and importance of formal psychoanalytic education. Apart from a sprinkling of graduate analysts, the audience was made up mostly of psychiatry residents and graduate students. Drawn by tentative interest, but checked by wariness, participants came for information to help them decide whether to pursue analytic training. Gann spoke eloquently about his experience as an analyst and the advantages he felt had accrued from his education. But the questions and comments from the group were equally eloquent and compelling: “Can I earn a living as a psychoanalyst?” “I’m not sure I can commit to five years of training at this point in my life.” “I’m not sure I want to be in analysis or leave my therapy or invest in this future.” You could imagine a voice offstage: “Is this profession still relevant in the day of biological and cognitive approaches to treating mental disorders?”
A number of participants said they wished they could enter psychoanalytic training. But they just could not see how they could manage the time and financial requirements of training, given their present circumstances and their uncertainty about the value of the training. One of us (RCF) was present, listening in, and felt despairing, as it seemed extremely unlikely that any in this group of ambivalently motivated potential recruits would become analysts. The best the discussion leader could do to address these issues was to say that, for him, it was worth the sacrifices required. In other words, “Trust me.” It was clear that significant changes would have to be made if these students were to take Gann’s advice. We would have to provide interested students the opportunity to decide for themselves that the value of psychoanalytic training was worth the sacrifices required.
The fertile fields of the 1950s had become the desert of the 2000s. A popular explanation was that we had lost cultural currency. We had been replaced both by new therapeutic approaches that promised greater benefits, faster and at a fraction of the price—CBT, DBT, Prozac—and by other sorts of mental and physical approaches: yoga, mindfulness training, EMDR. Despite Morris’s affirmation in 1992, just a year later a Time magazine cover asked, “Is Freud Dead?” The article left the question unanswered, and in the following years we saw more Time covers: “Faith and Healing,” “Meditation,” “The Science of Happiness,” and a reprise, “How Faith Can Heal!” Psychoanalysis had disappeared.
A second problem was that we no longer were part of a developmental sequence. The psychiatric residencies, clinical psychology programs, and social work programs that had based their models of the mind and approaches to treatment on a psychoanalytic foundation had shifted to biological and behavioral approaches. There had been a time when graduates of these programs had turned to psychoanalytic training as their natural next step. No longer. The old model of providing formal psychoanalytic training to mental health professionals with considerable clinical experience, and a solid foundation of theory and development obtained in graduate programs, had vanished in most of the United States. The drought worsened.
In addition, graduates of these programs are often burdened with student loans and other demands on their time and finances, such as buying a home or starting a family, which compete with their interest in postgraduate education. While such life-stage concerns are not unique to this generation of clinicians, the sensibility around work-life balance has apparently shifted. Our own institute changed from weekend to weekday classes, as both candidates and faculty insisted they no longer wished to surrender leisure and family time to their profession. This shift has gained even greater momentum, as can be seen in the emergence of today’s gig culture. Bottom line: the value of becoming deeply immersed in psychoanalytic ways of thinking and practicing has been diminishing at the same time as the cost of analytic training in money and especially time is increasingly viewed as prohibitive.
Many institutes have started psychoanalytic psychotherapy programs, both as a way to engage students in a more feasible endeavor and as a means of finding work for their faculty members. Some of these programs have been quite successful, and our own led to a number of students moving on to analytic candidacy. But these programs face their own problems. For example, some students, encouraged by institute faculty, leave in the middle of psychotherapy training to become analytic candidates. This poaching disrupts the continuity of the student group. It leaves behind a cohort that then feels second-class and a teaching faculty that resents being seen as minor-league, an unintended but quite negative side effect. And the psychotherapy program’s faculty can strongly resent the faculty member who encouraged the student to shift, which is divisive for the faculty group. Clearly, a radically new approach to the recruitment and training of candidates was required.
A Solution to the Problem
We review here the experience of the Washington Psychoanalytic Institute (now the Washington Baltimore Psychoanalytic Institute) as it developed a new model of education that offers a two-year combined training for psychotherapists, academic scholars, and psychoanalytic candidates, followed by a three-year curriculum exclusively for those who have become analytic candidates. This combined-training model—the Psychoanalytic Studies Program (PSP)—enables innovative recruitment policies and reconceptualizes how psychoanalytic training can be delivered effectively. We make the perhaps audacious claim that this model is superior to the traditional model. We would prefer it even if candidate recruitment were not an issue. Below we will also present the early results of a study that compares a combined model with the traditional model, a study being conducted within the training and education section of ApsaA’s Department of Psychoanalytic Education. This study looks at the benefits, challenges, and liabilities associated with the various didactic educational structures used at APsaA institutes.
An Initial Effort to Study the Problem
In 2009 ten analysts at the Washington Institute formed a study group to rethink our approach to psychoanalytic education. We focused on the kind of institute we would construct were we free of all restrictions, including organizational constraints imposed by ApsaA through BOPS, and by the IPA, as well as limitations such as wishes of the membership, the need to attract students, and the requirement that organized classes be taken in a brick-and-mortar classroom. This was more an intellectual exercise than a planning group. We formed the study group in response to the painful fact that we had not started classes in a number of years and future prospects were dim. Our thesis was that the dearth of candidates was a consequence of the model’s being out of tune with current cultural and postgraduate educational realities. We also thought, perhaps defensively, that studying the unconscious and its vicissitudes remained compelling. We recognized that the dry spell had something to do with economics, but also that other structural and organizational factors were involved.
We needed to create a program that students would want to attend. We examined other learning communities, other institute models, and other traditions. We found that liberating. We thought we might want a whole different paradigm to support continuing interest in psychoanalysis. Free of the constraints of old structures, procedures, rules, and traditions, we considered new options. In particular, we began to recognize the importance of a developmental, collaborative, open system of learning that would work for all of us, no matter our status or level of experience. That is the kind of educational village in which we wanted to live.
We rather quickly (for a group of analysts) formalized a model based on emphasizing two principles we had come to articulate in the study group. First, interacting with life outside the narrow confines of the discipline promotes new ideas and enhances freedom to think. Second, a developmental model for educating clinicians and scholars is more consistent with the current zeitgeist than the evaluation-only model under which we had been trained. Initially, changing the model did not include modifying the training analyst system. Our study group focused instead on using these two principles to change the classroom experience.
Principle 1: Systems Need to Encourage Freedom of Thought
A central feature of working as an analyst is the freedom to think while under significant emotional pressure (Symington 1983; Ogden 1995). That is, to the extent possible, institutes should advance a culture of safety, coherence, and reality, operating in what Melanie Klein called the depressive position. When one reads the literature on psychoanalytic education, it is amazing that institutes have managed to survive, given their paranoiagenic structures. It is a tribute to the drawing power of the study of the unconscious that students, despite the many barriers to innovative thinking, continue to seek training as analysts and psychoanalytic psychotherapists. Some barriers are inherent. But others, outmoded or illogical from the outset, are of our own creation. These can be changed.
What are the basic problems? Remember that Freud (1937), in “Analysis Terminable and Interterminable,” called psychoanalysis one of the three “impossible professions.” The other two were education and government. Psychoanalytic treatment, psychoanalytic education, and its governance are triply damned.
What makes it impossible? The study of the unconscious requires overcoming powerfully held resistances. On a couch, behind a couch, in a supervisor’s office, or in a classroom, the forces that drive repression, hiding, protecting, and not knowing are omnipresent and powerful. Second, the immersion model is powerful and destabilizing. This turmoil creates room for new understandings and new ways of being. But it spills over into classroom discussions, relationships among members of a training cohort, and their attitudes toward teachers, supervisors, center staff, and administrators. The capacity to learn and develop within the milieu of these forces, not in spite of them, often distinguishes those who can succeed at being analytic clinicians from those who cannot. But in this enriching soup that nourishes an analytic identity, psychoanalysis has created structures that make the learning and transformations harder rather than easier.
Psychoanalytic training has been widely criticized for a rather long time, as early as in the 1940s (Balint 1948; Bernfeld 1962). More recent critiques (e.g., Bornstein 2004; Reeder 2004; Berman 2004) focus on the power relationships within the institute, which are operationalized in particular by the traditional training analyst system, especially as it limits governance to training analysts. Another power dynamic is the dual role of supervisor as mentor/teacher and evaluator. In some institutes, adherence to a particular model of mental functioning or clinical technique becomes an unspoken criterion for advancement, for both faculty and students. A lack of transparency in progression is confounding (Cabaniss et al. 2003; Rothstein 2017).
An argument advanced particularly by Kernberg (2006) is that the traditional training models reinforce conformity while suppressing innovation and dissent from mainstream views. For example, institutes have traditionally been very hierarchical—viewed as a kind of meritocracy by those at the top, but as an aristocracy or privileged network by those not selected into the training analyst group. In many institutes at the time Kernberg published his critique, a small group of training analysts controlled admission, progression, graduation, and promotion. The rationale for exclusion was rarely given. Kernberg has suggested that for a candidate or graduate analyst, progression is best accomplished by conforming to the dominant theoretical position of the training analysts and by developing positive personal relationships with those who make the promotions. This can create a paranoiagenic atmosphere, especially for dissidents. Candidates within a hierarchical institute find it hard to know if they are not being promoted because they have dissident ideas or because they are less competent than their colleagues. The clear message is that it is dangerous to challenge the status quo.
Why have these norms developed? Some of the elders of psychoanalysis passionately believe that they protect the field against the dilution of psychoanalytic truth and practice into a watered-down version that has the taste of psychoanalysis without the kick. Efforts at revision are often characterized as scandalous claims that “anything goes,” rendering them a priori unacceptable. Encouraging new ideas while staying within the big tent of psychoanalysis is challenging, but not impossible. It requires that the institute be open.
A. K. Rice and his pioneering colleagues at the Tavistock Institute developed important understandings of how groups and organizations operate. Miller and Rice (1967) expanded on Bion’s notions (1961) of the unconscious forces in groups. These forces, collected as basic assumptions, compete with the work task of the group. A core truth of this perspective is that closed systems die. Ongoing productive engagement in any group or organization requires a constant supply of new ideas, new people, new tensions, and new challenges. For a group to manage the threats that outside forces pose, while taking in the vital new imports, it needs flexible, semipermeable boundaries, as well as attention to tasks and roles. Institute boundaries have been rigid and have contributed to an intellectual ennui.
Are there systematic ways to promote open systems? Kernberg has been a leader in advocating for structural change in institutes. His paper on suicide prevention for psychoanalytic institutes and societies (Kernberg 2012) summarizes our problems and recommends several solutions or “rescue efforts” for avoiding our self-destruction: (1) establish a lifeline with local universities; (2) develop psychoanalytically oriented psychotherapy programs; (3) inject a research orientation into the institute’s organizational life; (4) present a realistic public image of the institute’s scientific achievements and concerns and its clinical and professional contributions; (5)
Not all institutes are able to actualize these guidelines. Developing standards, research, and public awareness are more in the domain of the national association, as this work requires special knowledge and considerable personnel time. However, the orienting principle of openness can be followed even if the resources for full implementation are not available. The combined model presented below follows the openness principle, if in a way different from that prescribed by Kernberg.
Why is collaboration within a university at the top of Kernberg’s list? Levy (2009) speaks to his experience with a university-based model of education and training. Most institutes are more like trade schools than intellectual centers. The hubbub, debate, and cross-fertilization of ideas from related fields that typify university intellectual life provide an antidote to what he sees as the moribund state of the transfer of received wisdom in a free-standing analytic institute.
Levy’s idea is that the status and relevance of psychoanalysis require its engagement with interested colleagues from other disciplines, as are found at a university. His university-based institute (Emory) has an educational program for analytic candidates that is shared by students from fields ranging from the humanities, art, and anthropology to the neurosciences, all of them interested in learning about psychoanalysis.
In our application of Levy’s model, the first goal is to become educated in psychoanalysis as a theory of mind and a research tool, with its clinical application minimized. Mastering the knowledge base and sharpening nonclinical analytic skills leave the student freer to think, and this then allows for a deeper experience with the material of psychoanalysis and psychoanalytic psychotherapy.
Our institute has not formally joined a university, though we are now housed at one (The George Washington University Department of Psychiatry). Nonetheless, we have incorporated some of Levy’s principles into our training model. We decided to welcome academic scholars into our cohort of first-year students. Not just scholars who wanted to be “research analysts” (too high a bar for most), but those interested in psychoanalysis as a field of study. We discovered that they were eager to have exchanges with practicing clinicians that would expand their thinking.
We have tried to fashion links with the university we are situated in, with limited success. Psychoanalysis has been broadly devalued in universities in the recent past, perceived as no longer in fashion or intellectually useful; even the interest in Lacan and the deconstructionists has largely evaporated, giving way to more politically useful orientations. Engaging academia will be a challenge. Institutes like Emory that are integrated into universities may have more success at making connections than we have had.
Academic scholars as a group are rather assertive, having been trained in critical thinking and valuing dialectical interaction as a learning tool. They offer needed counterpoint to the forces of compliance often felt by inexperienced clinicians in the presence of senior analysts. By recruiting and welcoming these scholars into the basic cohort of PSP students, we hoped to reap some of the openness and freedom to think that Levy outlined, without giving up the autonomy of a free-standing institute.
We also included psychoanalytic psychotherapy students in our cohort. The presence of students who value their identity as psychoanalytic therapists counters the tendency to devalue psychotherapy in analysis-only education. For students who are deciding if they want to become analysts, seeing the similarities and differences between analysis and psychoanalytic psychotherapy, and understanding why peers choose one path or the other, enhance their decision making.
There are at least two other factors worth noting in trying to understand the shift of some psychotherapy students to psychoanalytic training. Several of these students entered personal analyses during their training in the PSP, and then identified with their analysts and found the work compelling. As more students became candidates during the two years of PSP training, some of their remaining classmates wanted to stay with their now-candidate colleagues, reflecting the power of group identification.
Kernberg’s fifth guideline encourages innovation. Modifying the training analyst system, while seemingly radical in the institutional context, has not yet been the panacea some thought it to be. And though promoting competent teachers is a solid if not particularly innovative idea, our study group felt, as William James said, that “a difference that makes no difference is no difference at all.” During our discussions, we agreed that our second principle—a developmental orientation—would make a difference.
Principle 2: A Developmental Orientation is Appropriate to Learning and Continuing Education
Around the time our study group was meeting, we learned that the San Francisco Center for Psychoanalysis had developed what it called a developmental model for appointing training analysts. In this approach, interested graduates join study groups in which clinical material is presented, papers are reviewed, and the wisdom of current training analysts is passed along. This is all in the service of developing the skills necessary for recent graduates to become training analysts. In the process, the prospective training analyst and his or her supportive group can also see if the candidate is able to develop such skills. The approach was not a vetting process, but it had the effect of helping those who are qualified to develop their skills.
Compare this approach to the usual approach at the time the PSP was born. After analytic candidates graduate, they go off to work and learn on their own, deciding if they want to run the certification gauntlet, put themselves forward to be evaluated by the certification committee, and then by their institute again. This approach is completely evaluative and counts on self-learning by the graduate. In it, colleagues are judges, not teachers or mentors.
The San Francisco Center’s developmental approach to educating and then appointing training analysts was compelling, close to what we do in our daily work, and, with some modifications, seemed a good orientation for all of psychoanalytic education. The Columbia Center has developed a comprehensive approach to training based on these same principles but in a somewhat different way, in response to local issues.
The Development of Psychoanalytic Clinicians and Scholars
Our model is organized around two important career stages for psychoanalytic clinicians and scholars. The first is the entry into psychoanalytic education. The developmental model would recruit clinicians and scholars interested in learning about psychoanalysis to take shared seminars of formal learning and would attend to their relevant career issues. The second stage would involve choosing a path for development. We believe that barriers to entering the institute should be as low as possible, consistent with maintaining the seriousness and integrity of the program.
As mentioned, most recent graduates of social work, psychology, and psychiatry programs need foundational work. We believe that this should stress education in the psychoanalytic model of the mind, supervised clinical experience with patients in psychotherapy, and, for those who are developmentally ready, psychoanalysis. At the foundational level of education, we do not see any difference between those who will pursue careers as psychotherapists and those who will pursue careers as both psychotherapists and psychoanalysts. Again, we think nonclinicians can both contribute to and benefit from most of these discussions. Scholars often know theory better than their classmates, and sometimes better than their instructors, but benefit from learning from clinicians who have toiled in the trenches. Altogether, our model would have a community studying psychoanalysis, developing their knowledge base, and engaging with a network of like-minded students from different orientations and levels of experience. From this communal learning, some students would choose the path to doing psychoanalytic work, some would focus on psychotherapy practice, and some would deepen their understanding of applied psychoanalysis. It is important that some students could be counseled out of this kind of program, or choose to leave, without stigma.
An education and training program should recognize and respect the developmental stages of prospective students and be flexible enough to meet them there. This is closer to an adult education model than to a training program or apprenticeship. Adult mid-career students, with advice and support, are responsible for their own education.
Operationalizing our Two Principles
We now turn to how the Washington Institute operationalized the ideas emerging from our study group. There were several points when the entire enterprise nearly collapsed because of strong objections—either that the changes were not sufficiently progressive or, contrarily, that they failed to promote a psychoanalytic identity. However, necessity was the midwife of invention, as the crisis in our identity as an educational program was unavoidable.
We hoped our new model would
Provide students the basic background in psychoanalysis that once would have been acquired in graduate school or a psychiatric residency.
Be a forum for the exchange of ideas, perspectives, and areas of expertise and interest among therapists, analysts, and academics.
Be flexible enough that a student interested in becoming an analyst, but wary of the investment required, could enter the program without fully committing to psychoanalytic training.
Not require being in psychoanalysis to enter the program. Switching analysts, or shifting from a personal therapist to an analyst, would not be required for matriculation. Being in analysis would be a developmentally based decision. In this way it would be closer to a personal analysis than a training analysis.
Provide expanded networking possibilities—for clinicians to enhance their practices and for scholars to work with collaborators.
Allow greater flexibility for students in the first two years to start and stop as needed, and to take a full or partial course load depending on their resources and circumstances.
Offer a curriculum that clarifies similarities and differences between psychoanalysis and psychotherapy in a nonhierarchical way, validating different career paths based on interests and logistics.
Provide advanced psychoanalytic psychotherapy training for all clinical students, which, in any event, will probably constitute the bulk of their practices.
Recognize that psychotherapy and psychoanalytic careers require similar intellectual and emotional capabilities and development.
The new, two-year program, called the Psychoanalytic Studies Program (PSP), was a variant of other combined programs (Institute of the Carolinas, Emory) in which institute classes included students other than psychoanalytic candidates. Our combined model, however, did not simply modify a current offering to include additional students. Rather, it was a new, integrative program for psychotherapists, academic scholars, and analytic candidates with a special curriculum and new admission, progression, and graduation policies and procedures. Thus, it was both not original and, from our perspective, revolutionarily original.
Recruitment
In 2012, with trepidation and excitement, we did a mass mailing about our changed offering. Under the heading “Where Classical Meets Modern” (accompanied by a picture of a modern sculpture of Freud that is housed in the New Center for Psychoanalysis in Los Angeles), we outlined the Psychoanalytic Studies Program. We mailed to everyone we could think of, but especially to university departments. We held several open houses and posted a video describing the new program on our website. The response was overwhelming. From having no candidates and a moribund psychotherapy program, we now found ourselves with twenty-two first-year students. We concluded that the difference could be attributed to the change in philosophy, the manageability of the offering, and the changes in admission criteria (see below) rather than to the method of recruitment.
Admission
To accord with our development principle, we made admission to the program contingent on meeting three criteria: (1) an interest in psychoanalysis, (2) demonstrated ability to benefit from advanced educational opportunities (usually meaning completion of a graduate degree), and (3) willingness to cooperate with the educational venture (e.g., being a good classmate, cooperating with administrative requirements). We considered suitability only when there were significant concerns about maturity as a clinician or personality instability. That is, we looked for an interest and potential aptitude for being a psychoanalytic clinician or scholar without asking the student to be well-schooled or experienced in psychoanalytic theory or technique.
We provided three categories of student application: scholar, psychoanalytic psychotherapist, and psychoanalytic candidate. Students could enter the program at the place that met their developmental needs and current aspirations. Psychotherapists and scholars could ask to shift their status to candidate at any time during the two-year program. They would submit a separate application for candidacy admission to the institute. However, this could now be done in an efficient and expedited process, as the applicants’ strengths and weaknesses were well known by then to the faculty and supervisors who had worked with them. This provided far more reliable vetting than the usual cross-sectional interviews. Most important, classes taken before the change in status would be credited toward graduation from the institute, potentially shortening the overall length of training.
Non-candidate students could take the program full- or part-time. As an incentive to enter psychoanalysis, we established a panel of analysts (now numbering twenty-two) who were willing to treat students at significantly reduced fees, based on need, with a generous formula provided for use in negotiating the fee. Our panel of volunteers included several training analysts. It was also stipulated that the agreed-upon fee would continue after the student finished the PSP, until the point of therapeutic completion, whether the student became an analytic candidate or not, to be modified only in response to a change in the student’s economic situation. Many students would have seen required analysis as demanding too great a commitment from them. But many of those who had not been in analysis at matriculation began an analysis during the PSP as a result of their exposure to the usefulness of psychoanalysis and their identification with teachers and supervisors.
The first year’s class included two candidates, four scholars, and sixteen psychotherapists. By the end of the two-year program, nine students had shifted to being analytic candidates. This is the advantage of our educational structure: students can experiment with psychoanalytic training without making a full commitment at the outset. We imagine that they might also have had the sense that they were already halfway through the analytic coursework, so that what remained would not be a huge ordeal in terms of time and money. But we also think that after experiencing the excitement of learning psychoanalysis and the positive effects of this learning on their practices and their scholarship, continuing their education made sense. That is, it provided students the same experiential evidence that Erik Gann had offered as his reasons for becoming an analyst.
After this first class of twenty-two, we expected a progressive drop-off in enrollment as the reservoir of potential students in the community drained. Remarkably, this has not been the case. We did drop down to fourteen students in the second year (no surprise), but we have held steady at that level for the past six years. Significantly, only a single student, on average, has entered as an analytic candidate at the start of the program. But by the end of the two years, typically. about half the students in the cohort have signed on for analytic training. We can imagine that if we were still operating in our old format, we would have acquired very few of these candidates. In short, this program has saved our institute’s life.
Progression
PSP students are not evaluated by a student equivalent of our Candidates’ Progress Committee. As with most adult education programs, the responsibility for learning is placed on the students, provided they are cooperating with teachers and classmates. We do not grade their coursework. Feedback reflects the instructors’ understanding of each student’s learning style—what is working well and what can be improved. The quiet student is encouraged to increase participation. The student who asks questions but does not make comments is encouraged to find his or her voice. The student who crowds out others is urged to pay attention to the needs of classmates.
Students who from the start matriculate into the PSP as candidates are followed and evaluated by the institute’s progression ommittee in a traditional way, aided by an advisor. Candidates can start control work during their first year after receiving approval from the progression committee. Students who transition to candidate status during the first two years are followed by the progression committee in the same way.
Graduation from the PSP is achieved by completing the coursework and meeting the supervision requirement. Graduation from the institute is achieved by meeting ApsaA’s graduation requirements in the usual way.
Clinical Skills Development
Each clinician is required to be in supervision with an institute supervisor, often a supervising analyst. The supervisory fee is fixed at seventy-five dollars. A student can have more than one supervisor. Supervision is aimed at developing technical skills. While several courses focus on the clinical situation and clinical theory, the how-to or what-do-you-say-when aspects are delegated to the supervision. This allows the classes to be directed at how to think rather than what to say. Since the PSP does not include courses in psychoanalytic technique, we encourage the supervisors to lengthen their supervisory sessions to include time for teaching technical fundamentals. Psychoanalytic technique classes are offered in the third year, after completion of the PSP, when all the students are in formal analytic training.
Curriculum
The curriculum focuses on ideas rather than practices. In the first year the students take three tracks, each having thirty classes. The theory track, rather than teaching the ideas of major theorists, focuses on concepts. We started this track with five six-week courses on attachment, conflict, motivation, the unconscious, and language. In each of these courses, we explore a range of ideas about the topic, drawing on a diversity of approaches and encouraging students to find their own understandings. The clinical track does not teach technique, instead offering three ten-week courses: Role, Task, and Boundary, covering the structure of the therapeutic situation; Transference and Countertransference, with readings from various orientations; and Theories of Therapeutic Action, which compares different approaches’ understandings of how treatment effects change. The third track offers two thirty-week electives. A course on Freud reads his major works, tracking the evolution of his thinking over his career. The Infant-Mother Observation seminar involves weekly observations of a mother and her baby in their home. In an associated seminar, the participants offer detailed accounts of what they have witnessed, paying attention to their own emotional responses and associations. We think that this course should be very useful to our scholar students, offering them an experience that is close to clinical work, as they use their empathy and imagination to process this encounter. We think that students intending to become analytic candidates should take the Freud course, although we do not require it.
The main work of the second year is a series of continuous case conferences—a psychotherapy, a child analysis, and an adult analysis, each paired with a theory course. The psychotherapies are presented by students, the analyses by advanced candidates or faculty. The theory courses are driven by issues arising in the casework. The theory teacher sits in on the continuous case meeting and, with the students, selects readings related to issues that arise in the clinical discussion. The third track in the second year offers the choice of the elective not taken in the first year or a full-year course on the writings of Melanie Klein, Wilfred Bion, their colleagues, and contemporary Kleinians. This last elective was created in response to both student interest and the faculty’s idea of where psychoanalysis is headed theoretically. Other institutes might see the value in different electives. We are evaluating whether this initial decision should be maintained or modified.
A number of our scholar students have continued with us in a study group that focuses on the psychology of the classroom; we expect to generate publications. We also offer our scholars the opportunity to link up with a senior authority in their field, selected on a nationwide basis. We have tried without success to offer our psychotherapy students who do not go on to analytic candidacy a third year of training based on topics of interest to them. We continue to pursue this, but the problem seems to be that those who want further training have become analytic candidates. We have a rich third- and fourth-year psychoanalytic curriculum, which has included courses on technique, dreams, primitive mental states, infant-mother observation, gender, sexuality, trauma, writing, and clinical process, as well as continuous case seminars, faculty presentations of their work, and a fifty-week sequence on human development,
Outcomes
Principal Positive Outcome: Survival of the Institute
We have had six years of classes under this model, enough to see if it has accomplished some or all of the goals we started out with. We exceeded expectations in meeting our goal of revitalizing the institute by increasing the number of students and improving the morale of faculty and administrators. We decided to limit the number of first-year students to fourteen (down from twenty-two originally), a few of whom are part-time, and have had full classes since the change.
Students have expressed high satisfaction with the program through their evaluations and, tacitly, through the very limited attrition of matriculated students. Over the five years, only a few have dropped out because they felt the program did not meet their needs. This was advantageous to both the students and the institute, as it allowed a simple withdrawal without creating administrative complications or damaging the students’ self-esteem. Several other students are on leaves of absence for personal reasons. All the others have graduated or are currently in classes. The goal of providing a learning environment to test one’s decision about the viability and value of analytic training was met both by those who chose to make a commitment to analytic training and by those who did not.
Diversity
We did not anticipate that the change in models would increase the racial, ethnic, age, and sexual orientation diversity of the student population, but it did significantly. In retrospect, we see that lowering the barrier to admission to the Center had the effect of lowering (though of course not eliminating) the sense of a racially and ethnically closed shop. This change, long sought in the institute, was very welcome and has contributed to interchanges among students and faculty that had not previously been possible. Coming to fully appreciate how culture influences learning as one becomes a psychoanalytic clinician is a work in progress, but the work is much easier with students who bring varied sensibilities to the learning tasks. We also have, on average, a much younger cohort of students than in the past. This has the important advantage for students of being educated and forming an analytic identity at the beginning of their professional life.
Faculty Morale
With more classes, more faculty are involved with the intellectual life of the institute. Many report that it is quite gratifying to be able to teach and learn with interested, able students. Having more students requires the faculty to take on multiple roles. We need more teachers, more advisors and mentors, more supervisors, more personal analysts. Participation in a range of roles increases the sense of being a valued member of our analytic community. Faculty meetings, once poorly attended, now draw a crowd, as it has become clear that faculty input in educational issues is taken seriously. This has helped the institute change its policy on the appointment of training and supervising analysts without much controversy. It has made possible a relatively smooth merger between the Baltimore Washington and Washington Centers. And it has allowed for adopting new standards of training. While it is difficult to attribute all of these changes to our new model of training, it is likely that having an involved, active faculty who have a stake in our educational endeavors has made differences of opinion about policy less central to their identity as faculty members.
Financial Considerations
Before the change, the institute had for many years been operating with budget deficits. Since the change, it has been a successful generator of revenue, and this has eliminated the need to raise dues or tuition to remain financially viable.
Increased Networking for Students
Larger, more diverse classes have increased the networking opportunities for students. Training together rather than separately also reduces the notion of first- and second-class students in the program. This too is a work in progress, as the old bias that places psychoanalysis at the top of a value hierarchy, rather than considering it one path among several, is resistant to change.
Challenges with the New Model
Teaching Challenges
Teaching students from different levels of experience and with different knowledge bases about psychoanalysis has been challenging. It requires faculty to be well-prepared, cognizant of group dynamics, and able both to teach and to facilitate discussion. The need for these qualifications is not particularly new to this model, but the need is heightened in a program where scholars with no clinical experience interact with both relatively inexperienced clinicians and others who have had postgraduate training in psychoanalytic theory and technique. The orienting principle that the curriculum focuses on foundational knowledge might appear to be a disadvantage for more experienced students. We have found, however, that much of what they have learned is in need of revision. That is, some students had not fully understood the complex concepts they thought they had mastered. Also, knowledgeable students are encouraged to share what they know, while less-informed students are encouraged to ask questions and to tolerate for a while their not understanding completely. This has allowed the attentive teacher to find the right balance between teaching beginning concepts and facilitating nuanced advanced discussions about key concepts. However, some teachers find it less satisfying teaching the mixture of candidate and non-candidates together, and students often find that teachers (unwittingly for the most part) tend to diminish the value of psychotherapy relative to psychoanalysis. (For example, almost all the articles they assign are about psychoanalysis rather than psychotherapy.)
Yet another teaching challenge is integrating the participation style of scholars with that of clinicians. Academic scholars are encouraged in their development at the university to maximize airtime, to compete with received wisdom, and to stake out positions. Clinicians, being uncertain about their knowledge, tend to be less comfortable seizing the floor and are more ready to identify with the teacher’s perspective. We have advised our scholar students to be aware of the culture of clinical learning and sensitive to the reticence of clinicians and have encouraged clinicians (and teachers) to become more comfortable with dialectical exchanges. With some notable speed bumps, this has mostly worked. For example, clinicians who initially resented scholars being included in the program came to value their contributions and accept them as colleagues. And some of our scholars have decided to seek graduate training in mental health fields in order to pursue a clinical career.
Analytic Identity
The strongest objection from some faculty members to the change from a classical model to a combined model involved the issue of how one forms an analytic identity. Some were quite worried that blending psychotherapists with scholars would dilute the identity-coherence of the future psychoanalysts. Immersion in the classical model meant to them immersion with a cohort of candidates, all in analysis, all seeing patients in analysis, and all working toward the same goal. The elements that contribute to the formation of an analytic identity, while viewed as essential by most analysts, are hard to specify. Identity itself is bit difficult to conceptualize in this context.
Erikson (1956) presents a helpful description of identity formation at the end of adolescence in his seminal paper on identity: Identity formation, finally, begins where the usefulness of identification ends. It arises from the selective repudiation and mutual assimilation of childhood identifications, and their absorption in a new configuration, which, in turn, is dependent on the process by which a society (often through subsocieties) identifies the young individual, recognizing him as somebody who had to become the way he is, and who, being the way he is, is taken for granted. The community, often not without some initial mistrust, gives such recognition with a (more or less institutionalized) display of surprise and pleasure in making the acquaintance of a newly emerging individual. For the community, in turn, feels “recognized” by the individual who cares to ask for recognition; it can, by the same token, feel deeply—and vengefully—rejected by the individual who does not seem to care [pp. 68–69].
How does one move from identification to identity? The combined model, we feel, provides students experiential learning in which identifications with supervisors, analysts, and teachers are available to be “tried on.” This is no different from the classical model. However, identity formation also involves the processes of dedifferentiation and de-identification to find one’s personal solution to the kind of clinician one wants to become. The combined model, with its curricular emphasis on thinking rather than internalizing received wisdom—with the strong voices of scholars who have different sensibilities, and with interchanges between psychotherapy and psychoanalytic students and teachers—provides opportunities to see what identity fits best for each student. Six years after the program began, dilution of analytic identity seems no longer to be a concern. That is, new graduates, in the way Erikson describes it, have been welcomed into the community as analysts and have affirmed their membership in that society.
Conclusion and a Look to the Future
While we feel the creation of the Psychoanalytic Studies Program has exceeded our educational expectations and hopes for survival, it is a local creation that other institutes may not necessarily view in the same positive light. We have detailed our experience as a way to open up innovation, creativity, and most of all thinking within organized psychoanalytic education. We learned a lot about ourselves as an institute in the planning, implementation, and continuing application of this model. And while we recommend it as a place for other institutes to begin to think about the philosophy and pragmatics of their educational programs, it certainly is not the only way to approach psychoanalytic education. The classical model has been maintained for many decades because it has strengths that the combined model does not. We encourage educators to bravely look at their programs and have an open discussion among faculty and students about how they feel psychoanalytic education can thrive in their own twenty-first century village.
Postscript
As an aid to the discussion we recommend, we include as an appendix a working document developed to compare the classical model to the combined model. The conclusions within the cells are subjective currently but have been informed by members of ApsaA’s Department of Psychoanalytic Education’s Models of Training Task Force who have interviewed administrators from a number of institutes regarding their experience with their current training model. These cells look at educational issues. As we all know, in addition to educational variables, there are political and personal issues within all organizations that have an effect on what can and cannot be done. However, in our experience, keeping the focus on education may mitigate some of these effects. The matrix is offered with this focus in mind.
Footnotes
Appendix
The following matrix was originally developed as a way to generate discussion among members of a BOPS Committee on Institutes (COI) task force that looked at teaching challenges for combined training. It was presented to COI in January 2016 and expanded on by the Models of Training Task Force of the Training and Education section of APsaA’s Department of Psychoanalytic Education in 2018. The grid compares the proposed model to the classical model of training found in most ApsaA institutes across a number of educational variables.
Combined at Start, Separate Later (Washington-Baltimore model, perhaps others as well). The first two years are combined, with candidates, psychotherapists, and academic scholars studying together. Candidates are vetted for suitability. Psychotherapists and scholars are vetted for eligibility, with suitability in the background. The psychotherapists and scholars finish their formal studies after two years. Psychotherapists can elect a third year focusing on psychotherapy technique and special issues of psychoanalytic psychotherapy. Scholars can join a scholars’ study group. Candidates attend candidate-only classes for years 3, 4, and 5. Students can declare their candidacy at any time before or during the first two years. All candidates are required to be in psychoanalysis. Candidates begin control work as soon as they are approved by the institute’s progression committee.
Acknowledgements
The authors gratefully acknowledge the contributions of colleagues on the Combined Training Task Force of the Committee on Institutes and the Models of Training Task Force of the Training and Education Section of APsaA’s Department of Psychoanalytic Education. Submitted for publication February 9, 2020.