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Training cases define clinical immersion for candidates and are essential to their education, progression, and graduation. At the Columbia University Center for Psychoanalytic Training and Research, there are three steps to the recruitment of training cases: (1) evaluation and selection of patients for psychoanalysis (some apply to the center specifically for analysis, while others are cases from the candidate's psychotherapy practice who are converted for analysis); (2) what happens once an offer of analytic treatment is made; and (3) induction of treatment. While dropouts from treatment are expected, repeated dropouts can be demoralizing and detrimental to a candidate's education and progression.
Four years ago we published a paper reporting the dropout rate of training cases at the center who began treatment between September 2002 and July 2008 (Hamilton, Wininger, and Roose 2009). In that study of 141 cases we found that 40% of training cases drop out of treatment before the end of the first year of analysis; a striking fact was that half of these patients dropped out in the first month of treatment. A literature search in 2009 revealed only one paper (Frayn 1995) that had looked at this topic. A recent search reveals no new papers on this topic since that time.
In the 2009 paper we hypothesized that the timing and frequency of dropout in part reflected problems in technique during the induction and