Emergency Remote Training in Psychoanalysis and Psychotherapy: An Initial Assessment from Columbia

Abstract

The Covid-19 pandemic and the social distancing required to combat it have set in motion an experiment in psychoanalytic education of unprecedented scope. Following an abrupt shift from in-person study to remote classes, supervision, clinical work, and training analyses, the Columbia University Center for Psychoanalytic Training and Research polled its psychotherapy and psychoanalysis trainees to assess their initial experience of remote training. Most candidates found the technical aspects of online learning easy and were satisfied with remote training overall. Across all programs, most trainees considered class length and reading load about right and felt their class participation was unaffected, though they found it harder to concentrate. Most found it no harder to start a training case, felt the shift to remote supervision had no negative effect, and were satisfied with seeing their training analyst remotely. Most trainees preferred in-person classes, clinical work, and training analyses to those offered remotely, yet in light of the health risks they said they were less likely to continue training in fall 2020 if in-person work resumed. Trainees suggested several modifications of teaching techniques to improve their participation and concentration in class. These findings’ implications for the debate regarding remote training in psychoanalysis are explored.

Keywords

candidates institutes remote training supervision psychoanalytic education distance learning teleanalysis training analysis Covid-19

With the outbreak of Covid-19 in New York City, the Columbia University Center for Psychoanalytic Training and Research canceled all in-person classes in our nine psychoanalytic and psychotherapy training programs on March 8, 2020. Four days later we moved all supervisions and clinical encounters to telemedicine platforms, including psychotherapy training cases, psychoanalytic control cases, and trainees’ personal therapy or training analyses. The following week we hosted our first psychoanalytic seminar via a HIPAA-compliant videoconference platform. In the span of less than two weeks we had embarked on an experiment in remote training. As of this writing (July 2020), all of these emergency adaptations to our training programs remain in place.

The transformation of our programs raised a number of questions. Most immediately, we wanted to know if our technology was working. Could trainees find and enter classes, see, hear, and be heard? Given their life challenges, could they make it to class and do their reading? Next, our questions focused on the quality of the educational experience we were providing and our trainees’ satisfaction with it. That information would enable us to improve the remote training experience and, just as important, to decide when to resume in-person study, as greater trainee satisfaction with the remote program would lessen pressure for a return to in-person training.

Finally, we entertained larger, long-term questions, wondering which, if any, of these adaptations might be worth preserving following the resolution of the pandemic. Beyond addressing the current health crisis, remote training—a matter of interest and controversy for some time in psychoanalysis—could widely expand the reach of programs like ours if it could be accomplished without compromising the educational experience.

We devised a preliminary poll and a subsequent, more extensive survey to help answer these questions.

Remote Training in Psychoanalysis and Psychotherapy

Distance learning is a well-established practice across a wide range of disciplines and educational levels (Means, Bakia, and Murphy 2014). In 2013 over 30 percent of college students in the U.S. were enrolled in at least one online course, with much higher numbers reported overseas (Simonson, Zvacek, and Smaldino 2019). A meta-analysis conducted by the U.S. Department of Education (2010) strongly supported the efficacy of remote education, and hundreds of studies have evaluated the outcomes of internet-based education and blended learning¹ for health professionals, indicating an effectiveness on par with in-person instruction (Cook et al. 2008; Liu et al. 2016).

However, the role of distance learning in psychoanalytic training has been a subject of significant, at times heated debate.² While few have argued against the use of seminars or supervision conducted at a distance, the practice of remote training analyses—and teleanalysis in general—has been hotly contested and remains the principal objection to a broader acceptance of remote training.

Scharff (2013b), Merchant (2016), and Ehrlich (2019) have provided comprehensive reviews of the arguments for and against teleanalysis. Among the theoretical criticisms they cite are beliefs that boundaries and the frame are inherently compromised in teleanalysis, that the medium is incapable of providing sufficient holding or containment for analytic work, that it interferes with unconscious communication between analyst and patient, and that it cannot compensate for the loss of the body and the physical proximity of the pair.

While these concerns have been rebutted by some on theoretical grounds and through the presentation of clinical material (Bassen 2007; Eckardt 2011; Leffert 2003; Lemma 2015; Mirkin 2011; Scharff 2010, 2012; Wooldridge 2017), they have nevertheless limited the development of remote psychoanalytic training programs. For example, writing on the 2008 creation of the Latin American Institute of Psychoanalysis, García (2011) explains that while the new program offered its candidates online seminars, training analyses were required to be conducted in person, as interrupted “concentrated analyses” conducted by analysts periodically traveling to the candidates’ home countries. “Whether communication networks . . . could really replace concentrated analyses,” García writes, “is a question our governing body has not asked itself. The intensity of unconscious experience in the transference, fundamental for anyone undergoing analysis, does not seem possible to us without the physical presence of analyst and analysand in the session” (p. 731).

Meanwhile, two intersecting needs—the desire for psychoanalytic training among clinicians distant from analytic institutes, and the difficulty some American institutes have in attracting local candidates—together with the emergence of free videoconferencing platforms began slowly to promote the international growth of remote psychoanalytic training. As of April 2019, forty-three candidates residing outside the U.S. were training remotely in psychoanalysis at APsaA institutes (R. Fishkin 2020). Three APsaA institutes, in particular, offered remote training programs using teleanalysis for the training analysis; online supervision; and blended classrooms for didactics, with local trainees participating in person and distance trainees online (Moshtagh [2020] vividly describes her experience as one such remote candidate). It was not until 2019 that these remote candidates were granted the same status within APsaA as in-person candidates, a reflection of long-standing doubts about the value of remote training.

Many of these remote candidates began as participants in CAPA, the Chinese American Psychoanalytic Alliance, a pioneering nonprofit program providing online psychodynamic psychotherapy training and treatment to clinicians in China and a principal driver of the advancement of remote training in American psychoanalysis. Much of the psychoanalytic literature on remote training consists of qualitative and quantitative reports by CAPA members of their training program and its outcomes (Campbell 2020; L. Fishkin 2020; R. Fishkin 2020; Fishkin et al. 2011; Gordon 2020; Gordon and Lan 2017; Gordon, Wang, and Tune 2015; Snyder 2020a,b; Spira 2020; Sze and Wen 2020).

A 2015 survey of CAPA instructors, supervisors, and therapists, for example, found most considered remote psychodynamic psychotherapy training “slightly less effective” than in-person work (Gordon, Wang, and Tune 2015). A subsequent study of CAPA graduates reported as evidence of the program’s effectiveness the finding that graduate clinicians used psychoanalytic formulations for most of their cases. Their number of years of training in CAPA and the number of weekly sessions of graduates’ personal treatment positively correlated with a psychodynamic focus in their clinical work (Gordon and Lan 2017).

Covid-19 and the Emergency Adaptation of Treatment and Training

Such was the contested state of remote training in psychoanalysis when the Covid-19 pandemic struck and, with breathtaking speed, made it a necessity. Analytic institutes turned to remote teaching as the only way for psychoanalytic and psychotherapy training to continue. APsaA members, only 9 percent of whom had conducted analyses over the phone (and only 4 percent through an online video platform) as recently as 2011 (Scharff 2013), moved their entire practices to remote work.

A survey of 190 psychoanalytically oriented therapists gathered through professional networks and conducted shortly after the first U.S. stay-at-home orders (Békés et al. 2020), found that only a minority of respondents experienced any of the challenges theorists had predicted for teletherapy and teleanalysis, such as difficulty keeping professional boundaries (23.2%), less authenticity (22.1%), difficulty reading the patient’s emotions (27.4%), or feeling less connected to the patient (29.5%). Instead, most respondents felt as confident and competent working remotely as when conducting an in-person treatment and, accordingly, reported a reduction in their previously held negative attitudes toward online therapy. Still, only a minority (25.3%) viewed online therapy as equal in effectiveness to in-person treatment.

The sudden wealth of experience with teleanalysis and teletherapy has already generated a handful of early reports on conducting analytic treatments remotely in the time of Covid-19, arguing that the medium can support analyses, as long as one continues to think and work analytically (Zerbe 2020: Svenson 2020).

As at many other institutes, Columbia’s abrupt transition to online training was born of necessity, not experience or research, and has had to precede such findings. Having made the change, however, we sought to assess the value of the training we were offering. The surveys we report on here, we hoped, would help us improve our trainees’ experience, decide when we might transition back to in-person training, and consider the value of continuing remote training in some form even after the pandemic recedes.

Results

We gathered data through two online surveys of our trainees: a brief preliminary survey conducted one month after the transition to remote training, and a more extensive survey conducted two months after the transition. All trainees in six training programs were asked to participate: psychoanalysis (including candidates in adult, child, and adolescent/emerging adulthood programs), adult psychodynamic psychotherapy, child and adolescent psychodynamic psychotherapy, parent-infant psychotherapy, transference-focused psychotherapy, and a two-year training program for analysts seeking to analyze and supervise candidates (the Columbia Academy for Psychoanalytic Educators TSA program, or CAPE-TSA). All responses were anonymous.

The response rate among psychoanalytic candidates to the preliminary survey was 53 percent. Given a low response rate among trainees outside the psychoanalysis program, we report only the responses of candidates to that survey.

The higher response rates to the second survey (61 percent for candidates and 58 percent overall) are shown by program in Table 1. We report as “all trainees’ responses” those of all respondents combined. When candidates’ responses differ from those of the group as a whole, they are described separately. Not all respondents answered every question. Denominators for each response reflect the number of those polled who answered that question.

Table 1.

Second survey response rates

Training Program	Total polled	Responded	Response rate
Adult, Child, and Adolescent Psychoanalysis	36	22	61%
Adult Psychodynamic Psychotherapy	6	2	33%
CAPE-TSA	8	5	63%
Child and Adolescent Psychodynamic Psychotherapy	4	1	25%
Parent-Infant Psychotherapy	5	3	60%
Transference-Focused Psychotherapy	8	6	75%
TOTAL	67	39	58%

For a detailed overview of all survey results, see Tables 2 through 9.

Table 2.

Preliminary survey results (candidates only)

Question	Response	N	%
Given the new challenges you may be experiencing with work, family, etc., how easy or hard has it been to fit reading assignments, online classes, and supervision into your life?
	Extremely easy	1	5
	Somewhat easy	1	5
	Neither easy nor difficult	7	37
	Somewhat difficult	3	16
	Extremely difficult	7	37
	TOTAL	19	100
How easy or difficult have you found managing the technical aspects of online learning thus far (e.g., finding and using Zoom links for your class, connectivity from home, video and sound quality, communicating in class)?
	Extremely easy	7	37
	Somewhat easy	7	37
	Neither easy nor difficult	3	16
	Somewhat difficult	1	5
	Extremely difficult	1	5
	TOTAL	19	100
Overall, at this early point, how satisfied are you with remote learning at the Center?
	Extremely satisfied	6	33
	Somewhat satisfied	5	28
	Neither satisfied nor dissatisfied	4	22
	Somewhat dissatisfied	3	17
	Extremely dissatisfied	0	0
	TOTAL	18	100

Table 3.

Obstacles to training

		All trainees		Candidates
Question	Response	N	%	N	%
Given the new challenges you may be experiencing with work, family, etc., how easy or hard has it been to fit reading assignments, online classes, and supervision into your life?
	Extremely easy	1	3	0	0
	Somewhat easy	6	17	3	16
	Neither easy nor hard	9	26	5	26
	Somewhat hard	15	43	8	42
	Extremely hard	4	11	3	16
	TOTAL	35	100	19	100
Based on the information you have now about your obligations for the fall, how do you anticipate this may change for you next semester? In the fall, things will likely be:
	Much easier	2	6	2	11
	Somewhat easier	3	9	2	11
	About the same	18	53	10	53
	Somewhat harder	2	6	1	5
	Much harder	2	6	2	11
	Don’t have enough info at this time to answer	7	21	2	11
	TOTAL	34	100	19	100

Table 4.

Comparisons of in-person and remote class time, length, and reading load

		All Trainees				Candidates Only
		In-Person		Remote		In-Person		Remote
Question	Response	N	%	N	%	N	%	N	%
How would you describe the length of classes, both during in-person learning pre-Covid-19 and during remote learning now?
	Much too short	0	0	0	0	0	0	0	0
	A bit too short	2	5	1	3	0	0	0	0
	About right	31	82	26	72	16	76	12	63
	A Bit too long	5	13	8	22	5	24	6	32
	Much too long	0	0	1	3	0	0	1	5
	TOTAL	38	100	36	100	21	100	19	100
How would you describe the amount of reading assigned, both during in-person learning pre-Covid-19 and during remote learning now?
	Much too little	0	0	0	0	0	0	0	0
	A bit too little	1	3	1	3	0	0	0	0
	About right	29	78	24	69	14	70	11	58
	A Bit too much	7	19	8	23	6	30	7	37
	Much too much	0	0	2	6	0	0	1	5
	TOTAL	37	100	35	100	20	100	19	100
How would you describe the time of day at which classes are held, both during in-person learning pre-Covid-19 and during remote learning now?
	Very convenient	13	35	15	42	6	30	8	42
	Somewhat convenient	11	30	12	33	6	30	6	32
	Neither convenient nor inconvenient	5	14	7	19	3	15	5	26
	Somewhat inconvenient	7	19	0	0	5	25	0	0
	Very inconvenient	1	3	2	6	0	0	0	0
	TOTAL	37	100	36	100	20	100	19	100

Table 5.

Effect of shift to remote learning on class participation and concentration

Question	Response	All Trainees		Psychoanalytic
Question	Response	N	%	N	%
How has the shift to remote learning affected the extent to which you speak in class? I speak . . . in remote classes than I did in-person.
	Much less	0	0	0	0
	Somewhat less	16	44	10	53
	No effect	19	53	9	47
	Somewhat more	1	3	0	0
	Much more	0	0	0	0
	TOTAL	36	100	19	100
How has the shift to remote learning affected your ability to concentrate in class? I find it . . . to concentrate in remote classes than I did in the classroom.
	Much easier	0	0	0	0
	Somewhat easier	3	8	2	11
	No effect	14	39	4	21
	Somewhat harder	15	42	11	58
	Much harder	4	11	2	11
	TOTAL	36	100	19	100

Table 6.

Effect on case finding and supervision

		All Trainees		Psychoanalytic
Question	Response	N	%	N	%
[For those attempting to start a new training case only] Has the switch to remote clinical work made it harder for you to start a new training case?
	Definitely yes	3	20	3	33
	Probably yes	1	7	0	0
	Might or might not	4	27	4	44
	Probably not	5	33	1	11
	Definitely not	2	13	1	11
	TOTAL	15	100	9	100
How would you describe the effect of the shift from in-person to remote supervision on your supervisory experience?
	Extremely positive	2	6	2	11
	Somewhat positive	8	24	6	32
	Neither positive nor negative	19	56	9	47
	Somewhat negative	5	15	2	11
	Extremely negative	0	0	0	0
	TOTAL	34	100	19	100

Table 7.

Candidates’ training analyses

Question	Response	N	%
How have you and your analyst chosen to meet during this time for the most part?
	Telemedicine with face-to-face video	2	11
	Telemedicine with video on but not face to face	4	21
	Telemedicine with video off most of session	3	16
	Telephone	9	47
	Not meeting	1	5
	TOTAL	19	100
How satisfied are you with this method of meeting with your analyst?
	Extremely satisfied	6	32
	Somewhat satisfied	9	47
	Neither satisfied nor dissatisfied	3	16
	Somewhat dissatisfied	1	5
	Extremely dissatisfied	0	0
	TOTAL	19	100

Table 8.

Returning in fall 2020

		All trainees				Candidates
		Continue remote		Return to in-person		Continue remote		Return to in-person
		N	%	N	%	N	%	N	%
How would the continuation of remote classes or the return to in-person classes affect your decision regarding your enrollment for the fall?
	More inclined to take a leave or go part time	1	3	11	35	1	5	9	50
	No effect	20	63	19	61	11	58	9	50
	More inclined to attend full time	11	34	1	3	7	37	0	0
	TOTAL	32	100	31	100	19	100	18	100

Table 9.

Overall preferences for in-person vs. remote training components

		All Trainees		Psychoanalytic Candidates
		N	%	N	%
All things considered, how would you compare the remote and in-person versions of these training components?
Classes	Strongly prefer in-person	8	23	4	21
	Somewhat prefer in-person	12	34	6	32
	Feel similarly about both	7	20	3	16
	Somewhat prefer remote	7	20	5	26
	Strongly prefer remote	1	3	1	5
	TOTAL	35	100	19	100
Clinical work	Strongly prefer in-person	13	39	8	42
	Somewhat prefer in-person	14	42	8	42
	Feel similarly about both	4	12	2	11
	Somewhat prefer remote	1	3	1	5
	Strongly prefer remote	1	3	0	0
	TOTAL	33	100	19	100
Supervision	Strongly prefer in-person	4	12	0	0
	Somewhat prefer in-person	11	33	6	32
	Feel similarly about both	9	27	5	26
	Somewhat prefer remote	6	18	6	32
	Strongly prefer remote	3	9	2	11
	TOTAL	33	100	19	100
Training analysis /personal treatment	Strongly prefer in-person	10	30	5	26
	Somewhat prefer in-person	13	39	11	58
	Feel similarly about both	9	27	3	16
	Somewhat prefer remote	1	3	0	0
	Strongly prefer remote	0	0	0	0
	TOTAL	33	100	19	100

Preliminary Survey

Polled shortly after the onset of the pandemic in New York, our candidates were clearly struggling. When asked in the preliminary survey, “Given the new challenges you may be experiencing with work, family, etc., how easy or difficult has it been to fit reading assignments and online classes into your life?” 37% of candidates (7 of 19) replied that it was extremely difficult, and another 16% (3 of 19) said it was somewhat difficult. In response to an open-ended question, a few asked that teachers set aside some time to address the impact of the pandemic on their lives as a part of each class. One likened the experience to psychoanalytic training during wartime, paraphrasing Winnicott: “I should like to point out, there is an air raid going on.”

Notably, the logistics of connecting online posed little difficulty, with 74% (14/19) of candidates saying they found it extremely or somewhat easy to manage the technical aspects of online classes. Overall, even at this early point, satisfaction was relatively high, with most candidates (61%, 11/18) saying they were extremely or somewhat satisfied with remote learning. In response to open-ended questions, a number expressed gratitude that classes were continuing and were particularly thankful for the opportunity to connect with classmates.

Second Survey

Challenges

One month later, the pressures on our trainees appeared to have lessened somewhat. In the second survey, when asked again how easy or hard it had been to fit classes and reading into their lives, only 16% (3/19) of candidates answered extremely hard; 42% (8/19) now reported finding it somewhat hard. Across all of our programs, most trainees described meeting these training demands as somewhat or extremely hard and expected to be facing similar challenges in the fall.

Class time, class length, and reading load

We had not changed the time of classes in the switch to remote learning, but in the online setting trainees were more likely to find class time convenient. Most trainees considered the time of in-person classes to be very or somewhat convenient pre-Covid-19 (65%, 24/37), but more found remote class times convenient (75%, 27/36). While 25% (5/19) of candidates described in-person class times as inconvenient, no candidates considered remote learning class times inconvenient. (Psychoanalytic program classes are held midday, while all psychotherapy and CAPE-TSA classes are held in the evening.)

When asked to describe the length of classes, most trainees considered it “about right” whether conducted in-person (82%, 31/38) or remotely (72%, 26/36). However, trainees were more likely to find remote classes somewhat or much too long (25%, 9/36) than they were to feel the same about in-person classes (13%, 5/38). Psychoanalytic candidates, most of whom are in class six hours weekly (compared to two or fewer hours weekly for other trainees) were more likely than other trainees to find their classes too long when conducted in person (24%, 5/21) and especially so when remote (37%, 7/19). In response to an open-ended question about possible improvements to remote training, several trainees asked for classes to be shortened. One reported being in a program where that had been done with good effect.

Most trainees felt the amount of assigned reading was about right, whether pre-Covid-19 (78%, 29/37) or during remote training (69%, 24/35). However, they were less likely to report that the reading load was too much pre-Covid-19 (19%, 7/37) than during remote learning (29%, 10/35). Candidates (who have more reading assigned them than other trainees do) were more likely than others to report that the reading load was too much during in-person learning (30%, 6/19) and even more so during remote training (42%, 8/19).

Class participation and concentration

Class participation and concentration were both diminished in the emergency remote setting. While most found their class participation was not affected by the shift online, just under half of trainees (44%, 16/36) said they spoke somewhat less in remote than in-person classes. Just over half of all trainees (53%, 19/36) and a larger majority of candidates (68%, 13/19) said it was harder to concentrate in remote classes than in-person classes. Overall, most trainees (57%, 20/35) preferred in-person instruction to remote classes strongly (23%, 8/35) or somewhat (34%, 12/35).

Qualitative input on teaching techniques

In their answers to open-ended questions about teaching, trainees gave extensive feedback about which teaching techniques are most and least effective in the remote classroom. Trainees strongly emphasized the value of open and active discussion among participants. They wanted the opportunity to share their thoughts and hear from their classmates. Given the somewhat increased challenges to participation, trainees preferred teaching techniques that stimulated and, to a certain extent, structured discussions over attempts (which were often unsuccessful) to allow discussion to arise spontaneously. Instructors who used the screen-sharing function to show process notes for the class to analyze, screened video clips of psychotherapy sessions, or came prepared with thought-provoking questions for discussion received high praise.

Respondents were nearly unanimous in their dislike of lecture-based approaches, finding passive listening especially hard to attend to in the remote classroom. While summaries of a topic or of readings were described as helpful by some, trainees urged instructors to keep presentations brief (e.g., no more than fifteen minutes).

Finally, trainees appreciated instructors clearly setting out the agenda for the day’s class at the start, including identifying a planned break for the middle of class.

Clinical work and supervision

A large majority of trainees (82%, 27/33) preferred in-person clinical work to remote treatments either strongly (39%, 13/33) or somewhat (42%, 14/33). While some junior candidates had raised concerns about the impact of the pandemic on their ability to find and begin a new training case, only about one quarter (27%, 4/15) of trainees seeking to start a new training case felt that working remotely had made it harder for them to do so.

Most trainees described the switch to remote supervision as neither positive nor negative. But a sizable minority of all trainees (29%, 10/34) and an even larger percentage of candidates (42%, 8/19) found the switch to remote supervision to be positive. In fact, candidates were four times more likely to describe the move to telesupervision as positive than as negative. Notably, supervision in the psychoanalysis program was the only component of remote training that a plurality of trainees preferred to the in-person experience.

Training analyses

As for their remote training analyses, the vast majority of candidate respondents (79%, 15/19) were satisfied with this method of treatment. About half of candidates (47%, 9/19) reported seeing their analyst on a video platform and half were meeting via phone (47%, 9/19). Of those using video, most (7/9) kept the video off or faced away from the screen with the video on throughout most of the session. Nevertheless, 70% (23/33) preferred in-person to remote analysis.

Continuing remote versus returning to in-person training

We asked how continuing remote training or resuming in-person classes in the fall would affect trainees’ decisions to participate on a full-time basis or to go part-time or take a leave of absence. While 61% (19/31) of all trainees and 50% (9/18) of candidates said that a return to in-person training would not affect their decision to participate in the fall, 35% (11/31) of all trainees and 50% (9/18) of candidates said it would make them more likely to switch to part-time or take a leave of absence. Conversely, while 63% (20/32) of all trainees and 58% (11/19) of candidates said that continuing remote learning would not affect their decision to return in the fall, 34% of all trainees (11/32) and 37% (7/19) of candidates said that it would make them more likely to return as a full-time trainee.

In response to an open-ended question at the close of the survey (“Should remote learning continue in the fall, what changes if any would you like to see us make to the form or content of classes?”), 11 of 26 respondents took the opportunity to ask for a continuation of remote classes. None asked for a return to in-person classes. Trainees expressed particular concern with the health risks of taking public transportation to training sites.

Discussion

The abrupt transition to remote training in psychoanalysis and psychotherapy has brought institutes like ours new responsibilities and opportunities among the evident losses. It is incumbent upon us both to safeguard the health of our faculty and students and to examine the efficacy of remote training to ensure the best learning experiences for our trainees. At the same time, in requiring us to amend time-honored training practices, the pandemic has given us a chance to practice and study new modes of training with the potential to improve our programs, increase their accessibility, and expand their reach.

Our colleagues in medical education (Dedeilia et al. 2020; Guerandel et al. 2020; Hall et al. 2020; Liang, Ooi, and Wang 2020; Richards and DeBonis 2020; Rose 2020; Sklar 2020; Whelan 2020) and clinical psychology training (Bell et al. 2020; Hames et al. 2020) are deeply engaged in this process.

In their responses to the pandemic, training programs across a broad spectrum of disciplines and specialties have sought to strike a balance among the health interests of trainees, their advancement toward key learning objectives and certification requirements, and their fulfillment of patient care responsibilities in ways tailored to each program’s unique circumstances. Many have chosen to suspend or transform traditional learning experiences, devising a wealth of adaptations to keep learning going during the pandemic. Among the countless modifications being implemented, training programs are shifting toward competency-based assessment and away from tying trainee promotion to the number of procedures conducted or hours spent (Bell et al. 2020); adopting online analogs of live experiences, such as virtual dissection for anatomy students (Evans et al. 2020); transitioning to unproctored, open-book exams (Sandhu and de Wolf 2020); and promoting trainee wellness through novel mental health interventions (Richards and DeBonis 2020).

Where losses to trainee education, certification, and service demands are judged to outweigh health risks to students and faculty, in-person learning continues. At Columbia’s Vagelos College for Physicians and Surgeons, for example, the entire first-year curriculum will be taught remotely in the academic year 2020–2021, but medical students have already returned to the hospital for their clinical clerkships (Katznelson and Lynne 2020). In such cases, institutions like ours have put protective measures in place to reduce risks to in-person trainees. These may include requiring viral tests for all returning faculty, staff, and students; daily temperature checks and online health attestations for all members; the provision of personal protective equipment and safety training; and physical plant alterations, such as barriers, enhanced ventilation, and improved disinfection of work areas.

Viewed against this backdrop, our adaptations have been rather simple. In short order, and without significant modifications, we were able to move all classes, supervision, clinical work, and training analyses to telemedicine platforms. While our trainees prefer the in-person version of all training experiences except psychoanalytic supervision, their survey responses attest to the adequacy of remote training. Most candidates found the technical aspects of online learning easy and said they were satisfied with remote training overall. Across all of our programs, most trainees found online class time convenient, considered class length and reading load about right, and felt their class participation was unaffected, although their concentration was reduced. Most found it no harder to start a training case, felt the shift to remote supervision had no negative effect on their experience, and were satisfied with seeing their training analyst remotely. In light of their experience of remote training and their estimation of the health risks of in-person work, our trainees were not eager to return to it in the fall.

These results have already informed our training practices. Most notably, in concert with our university’s evolving policies, they have helped guide our decision to extend remote training in our psychoanalysis programs at least through the end of the fall 2020 semester and in our psychotherapy programs through the end of the 2020–2021 academic year. As noted, this decision contrasts with that of some other training programs on Columbia’s health sciences campus, where in-person training has already resumed.

Survey results have also pointed toward ways of improving remote instruction. We are now providing training in remote didactics to our instructors, advising them to adapt their teaching styles in simple ways to promote trainee participation and concentration, such as beginning each class by sharing a detailed schedule for the session, including a break; limiting to short segments the time spent lecturing; and stimulating and supporting trainee discussion and engagement using a variety of prompts.³ We have asked instructors to more consistently identify the single most important reading among those assigned for trainees whose time is especially limited and to consider shortening the length of their classes. Our faculty are presently developing didactic instruction in the practice of teleanalysis and teletherapy. Further adaptations will likely follow as we test these changes and continue to study the impact of remote training.

Beyond the Pandemic

In light of the contested status in psychoanalysis of remote training prior to the pandemic, the ramifications of experiences like ours are likely to extend well beyond next semester. Notably, a great deal of the literature on training adaptations across the health professions identifies pandemic-related innovations as educational practices that have long had their champions but that programs have been previously slow to adopt. Bell and colleagues (2020), for example, write that emergency adaptations to Covid-19 may have “functionally accelerated the evolution” of clinical psychology training, fast-tracking changes that would otherwise have occurred slowly or not at all. “Rather than simply returning to prepandemic training approaches once COVID-19 abates,” they write, “[clinical psychology] educators can use the adaptations and accommodations required by the pandemic as an opportunity to rethink usual training practices and consider more flexible and innovative ways to use distance education.”

For many years, remote supervision, training analyses, and classes have been explored as possible solutions to the needs of clinicians living far from analytic centers, as well as those of struggling or underresourced institutes. Objections to expanding their use have focused on the adequacy of the remote training analysis. While attesting the viability of remote training in general, and the satisfaction of candidates with their own teleanalysis, our data do not answer this particular concern. A much deeper investigation into their treatments would be required to shed light on the comparative efficacy of remote and in-person analyses. Such work would be challenging to conduct, but undoubtedly valuable.

Some have attributed analysts’ objections to teleanalysis, at least in part, to their lack of familiarity with the practice (see, e.g., R. Fishkin 2020; J. Scharff 2013a). If this is so, the impact of the pandemic on the acceptance of remote training methods may be profound, even in the absence of empirical data on teleanalysis. As Békés and colleagues have shown (2020), after fewer than two months of experience conducting teletherapy and teleanalysis during the pandemic, clinicians already viewed the modalities more positively. Our appreciation of the strengths and weaknesses of teleanalysis and its impact on training is sure to grow in the ensuing months. Moreover, with the global adoption of remote therapy and analysis, a trove of data is beginning to emerge that will undoubtedly bear upon the long-standing debates regarding teleanalysis and, consequently, remote training.

Limitations of the study

We expect that our trainees’ ratings of remote training were negatively impacted by a few variables unique to our circumstances. First, due to the emergency nature of our shift, our classes were not designed for distance learning. In-person training experiences were simply migrated, without significant modification, to an online medium.⁴ Further, our instructors were not yet trained in online teaching techniques. For many it was their first experience teaching online, treating patients remotely, and supervising trainees remotely. It is reasonable to imagine that a program specifically designed for distance learning would be experienced somewhat more favorably.

Moreover, our transition took place in the context of a health emergency that likely shaped trainees’ experience. Trainees, faculty, and patients were grappling with dramatic changes to their lives, financial burdens, time challenges, fears of illness and death, and grave concerns about their own future and that of the larger society. When we moved to remote training, New York was first a place of concern, then the national and then the global epicenter of the pandemic, and then, gradually, less threatened than other areas. By late March, our hospital’s medical units were repurposed into Covid-19 ICUs, and members of our department were reassigned to provide medical care for Covid-19 patients or put on notice that this might occur. Many of our members actively organized and provided direct support to hospital staff on the front lines. These stresses likely affected trainees’ reports of challenges with participation, attention, reading load, and class length. Conversely, the experience of a shared project of keeping training alive during the pandemic may have made them more forgiving of our programs’ shortcomings.

Finally, our response to the pandemic was guided and facilitated by our integration within a larger academic medical center, offering technological resources and collaboration with allied educators less readily available to stand-alone institutes.

Future Directions

As we continue to practice and examine remote training, there is much more we hope to learn. Having heard from trainees, we next need to examine the experience of our classroom instructors, supervisors, and training analysts. Of particular interest will be assessing the effects of remote training on trainees’ acquisition of skills. Finally, we hope to track our trainees’ experience of their ultimate return to in-person study both to elucidate further the gains and losses of remote work and to study the next major transformation in psychoanalytic training: the move back into the classroom and consultation room. For our most junior trainees, this will be an entirely new experience.

The advantages of remote training are evident. Hybrid models, choice of online or in-person training programs, and long-distance learning could dramatically enhance the accessibility and reach of our training programs. If we succeed in addressing some of remote training’s shortcomings, emergency adaptations such as ours could pave the way toward more enduring innovations in how we provide psychoanalytic and psychotherapy training. Further study of the feasibility, desirability, quality, and outcome of remote training should guide how we choose to use it once it is again safe to work in person.

Footnotes

Acknowledgements

The authors gratefully acknowledge the contributions of the following colleagues who helped develop and distribute these surveys: Christine Anzieu-Premmereur, Ruth Graver, David Gutman, Talia Hatzor, Sandra Park, Holly Schneier, Anna Schwartz, and Wendy Turchin. Submitted for publication July 8, 2020.

Justin Richardson, Chair of Training and Senior Associate Director, Columbia University Center for Psychoanalytic Training and Research; Assistant Clinical Professor of Psychiatry, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons. Deborah L. Cabaniss, Clinical Professor of Psychiatry, Associate Director of Residency Training, and Director of Psychotherapy Training, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons; Chair of Faculty Development and Training and Supervising Analyst, Columbia University Center for Psychoanalytic Training and Research. Sabrina Cherry, Associate Director and Training and Supervising Analyst, Columbia University Center for Psychoanalytic Training and Research; Associate Clinical Professor of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University. Jane Halperin, Associate Director and Chair of Mentor Program, Columbia University Center for Psychoanalytic Training and Research; Assistant Clinical Professor of Medical Psychology, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons. Susan C. Vaughan, Director, Columbia University Center for Psychoanalytic Training and Research; Associate Professor of Psychiatry, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons.

ORCID iDs

Justin Richardson

Sabrina Cherry

Susan Vaughan

Notes

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