An Essay On Psychoanalytic Training and Identity for the International Journal of Controversial Discussions

There has been a lot of discussion about the connotations of whether it should be called ‘training,’ or ‘education,’ and so forth. That seems much less important to me than to consider its goals. What are we seeking to instill? What do we want the outcome to be for each individual potential colleague? What's the point, for heaven's sake?

To consider and even to attempt to answer such questions, I have to start with myself. I am my best data source, and generalizing about others is at best an approximation, and, at worst, presumptuous. What follows is a brief survey of my own training history, experience as an educator, and some ideas about possible future directions.

When I was twelve, I wanted to be an archeologist, a microbiologist, or a psychoanalyst. Note the be. At the dawn of adolescence, I was imagining who I wanted to be when I grew up. It was about identity, not activity. Interestingly, these were all fields that sought to look beneath the surface and understand what went before and made things work. Given that I was not in a generation when women could easily go on digs and have babies, and that I was not great at science, that left psychoanalysis. Despite detours, that remained a central goal that I pursued when I finished college at 21.

Imagine my chagrin when I realized that, in the United States, I was expected to make myself into someone different first—I would have to be a doctor if I wanted to be a psychoanalyst. That didn't work for me. So I took myself off to London in 1964 and, after much campaigning, persuaded the Course Tutors at Anna Freud's Hampstead Clinic that

someone so young was sincere in the vocation. (I learned only many years later that Anna Freud was 22 when she read her membership paper for the Vienna Psychoanalytic Society, a complex and difficult experience that influenced her for the rest of her life, but that is another story, told in our paper ‘Creativity and Compliance.’2).

Unique among psychoanalytic trainings in the world then and now, the Hampstead Clinic was a full-time institution. Students spent all day every day, and many evenings for seminars, for four years, in a comprehensive range of activities. I didn't grasp then the extraordinarily consistent and coherent vision behind the design of our program.

It can be summed up in one word—it was a metapsychological approach. To Anna Freud, that meant immersion in learning from multiple perspectives and in multiple contexts how to think psychoanalytically. She conceptualized the essence of psychoanalysis to be its capacity to encompass the complexity of normal and pathological development and functioning. She did not make a hard and fast distinction between psychoanalysis as a general psychology and as a therapeutic modality.

To do what she envisioned, one had to learn to be capable of moving among perspectives, whether between levels and agencies of the mind, or players in the family scenario, or differing conceptualizations; one had to think simultaneously about the impact of experiences and capacities along a shifting continuum of time that affected functioning in complex ways; one had to consider and weigh the relative influences of different parts of the personality at any given moment and as they crystallized over time. This is what we hope for in all psychoanalysts – a capacity and commitment to think psychoanalytically. In this context of a discussion about training, however, I want to summarize how I think that particular training sought to realize those aims.

Doing something full-time defines it as essential. Psychoanalytic training at Hampstead was not an add-on or ancillary. There was no tuition and

quite ample scholarship support for personal analysis and supervision was available to those who needed it. That meant that no student had to be making a living doing something else while training – our attention and exercise of skills were not pulled in different directions by a day job.

Along with the explicit teaching and research about psychology and mental functioning, grounded in Freud's work, there were intrinsic and implicit assumptions conveyed about the value of each individual. This profoundly democratic idea and ideal issued from a person living in an autocratic imperium, who also had his own struggles to engage with about power and authority. But the ideas were there and made an impact. There were values to internalize from Freud's work and from the example of Anna Freud's lifelong attention to the needs of underserved and un-understood groups. Seeing every day during our training the women who had cared for the children flown from concentration camps to a safe haven and an endlessly understanding home at Bulldog's Bank offered us the measure of what analytic devotion entails.

There was another aspect of the structure of the training that I don't think I noticed particularly at the time. Everything at Hampstead happened in groups. When we weren't seeing our patients, or attending supervision, seminars, or our own analyses, our days were spent in meetings of groups doing research projects and conducting the activities of the Clinic. There was the Baby Group, the Concept Group, the Clinical Concept Group, the Diagnostic Group, the Nursery Group, the Index Group, the Borderline Group, and so on. That meant that we had to learn to listen to other points of view, to other ideas, to make a case for our own, to examine the logic and relevance of everything put forward. It was a collaborative endeavor that mandated intellectual honesty and encouraged inquiry.

We worked in the Nursery School, the Well-Baby Clinic, the Blind Nursery, did infant observations over two years, and we wrote and wrote. Everyone, staff and students, wrote a 1-page weekly report on each analytic case we were treating (75-100 per week and Anna Freud read every single one every week); we wrote annual summaries; we wrote diagnostic Profiles on each patient and terminal Profiles; literature reviews and concept discussion writeups were part of participating in each Group; each observer wrote notes from the Nursery School; everyone presented

a major paper at a Wednesday Meeting, some of us several times; a comprehensive Index of one of our training cases (running to at least 100 pages in a ring binder) fed into an extraordinary pool of analytic data, and so forth. My sense now is that we were led to thinking analytically by having to articulate what we were doing and why. What began as laborious requirements became more flexible and fluent facility in testing ideas and honing our understanding.

Our writing was valued and respected, not filed away in a training record. Many of the pieces done in research groups found their way into published volumes from Hampstead, which became classic textbooks for psychoanalytic education. We were also encouraged to pursue independent projects, which often resulted in publications in major journals, even while we were still students, for instance, the work Jack and I did on projection and externalization, and the development of beating fantasies in children (Novick and Kelly 1970, Novick J. and Novick, K.K. 1972)

One more characteristic is worthy of note. Many staff and faculty had private practices in their own offices, but they also saw patients at the Clinic itself, where we students worked. We all shared the Common Room, with its trolley for coffee, tea, and biscuits, the toy cupboards, and the typewriters on little tables. Looking back, I realize how much I gained from being with my teachers when they were nervous before they saw a new patient, thrilled or exasperated at the end of a session, comforting when one of us felt frustrated or confused. The work was demystified and teachers were not idealized. Hanging out and hearing about other students' work expanded my sense of the range of how material emerges and all the ways we can respond. The opportunities for identification were right there to build our analytic identities.

And, to jump-start that process, we did analysis from the very beginning. I started my first analytic training case in October of my first year and added subsequent cases within a few months. The underlying idea seemed to be that the best way to master something was to do it, not just hear or talk about it, an educational philosophy with a long progressive history. Anna Freud knew all about progressive education, from her own training as a kindergarten teacher, to the schools she and Dorothy Burlingham started at Hietzing and in the Jackson Nursery,

her knowledge of Maria Montessori's ideas, and her work with August Aichorn, Fritz Redl and many others (Danto 2018).

Fast forward through a dozen years, during which I had joined the staff of the Hampstead Clinic, started a private practice, and worked in a community psychiatry hospital, to my joining faculties of psychoanalytic training centers in a couple of locations after our return to the United States, while teaching and supervising child psychiatry residents and interns in a large university medical setting.

As a child psychoanalyst, I was usually asked to teach segments of the child development sequence to adult candidates. I was struck by how few candidates could bring to bear a framework of knowledge of ordinary childhood, a sense of normal development, to their work. American candidates seemed almost restricted by their prior professional trainings to a focus on pathology and diagnosis, limiting their view of psychoanalysis to only a set of narrowly-defined therapeutic techniques. They also seemed to struggle with the cognitive dissonance between helping people and making an effective living using other treatment modalities, and being taught that psychoanalysis was so much better. Talking about normal and pathological dynamics and growth in children and adolescents and their families and linking this to analytic concepts in other seminars became something of a mission for me.

Eventually, since APsaA trainings were still not available to non-physicians, I sought training in adult psychoanalysis at an independent institute where other non-medical colleagues were in the majority and the analytic tradition was more eclectic. I have come to think that it was important to me that I did both segments of my analytic training in places that were outside the mainstream of established organizational psychoanalysis. Our trainings create multiple and complex transferences and few of them make an explicit effort to reduce these or address idealizations; I have wondered if they may be unconsciously fostered and perpetuated to maintain a power hierarchy by the elders in a group.

Around the same time, the GAPP lawsuit was settled, so APsaA opened to non-medical analysts and we started a child analytic training at my local institute. Within the decade, our group made a radical shift in designing and implementing the first integrated psychoanalytic training. I

think this model has far-reaching implications for the future of analytic training all over the world and, for me, it brought to operational reality the principles of Anna Freud's “ideal institute,” where everyone would be trained in what has come to be called “life-cycle psychoanalysis” (A. Freud 1971).

Toward the end of that busy time in the 1980s, a group of us also started working together toward founding a non-profit psychoanalytic school in our town. In 1994 this became Allen Creek Preschool () and it has gained an important place as a community institution, as well as winning awards from various psychoanalytic organizations. I refer to Allen Creek here, however, because it offered a profoundly influential educational experience for me and all the colleagues and candidates who have volunteered there.

Working with teachers and parents at Allen Creek, in the 0-6 programs and in outreach work throughout Southeast Michigan, challenged me to speak clearly as a psychoanalyst. Rather than turning inward and communicating only with each other in ever more abstruse jargon, looking outward to the community to apply what we know made us as analysts examine our ideas anew, testing them in the practical laboratory of daily life for families. This in turn reverberated in my clinical technique with patients of all ages. I strongly advocate that all students of psychoanalysis spend significant time in schools, daycares, businesses, so that they learn to communicate straightforwardly, not only for outreach and application, but also better to serve their patients and build an equitable therapeutic relationship.

Turning briefly to some ideas about the future of psychoanalytic education, I think it's important to state that I do think it has a future, with the reservation that it will need to change for that to come true. The psychoanalytic world will need to build its tolerance for experimentation, and be brave and open enough to examine and compare training models and methods. The IPA began to recognize this with the adoption of multiple training models some years ago, and the ongoing realization of the multiple variations within them, but there is a long way to go before the IPA sees its way clear to open consideration of alternatives that include elements discernible in the Hampstead Clinic training, or the Affective Learning Model described by Jill and David Scharff (2000).

Ten years ago, Jack Novick, Denia Barrett, Tom Barrett, and I, concerned about decreasing numbers of child analytic candidates and cases in the US, devised a pilot program for a training that we called NewCAPT (New Child and Adolescent Psychoanalytic Training). Under the auspices of the Alliance for Psychoanalytic Schools (APS) () we designed a program that we hoped would incorporate some of the elements we thought were significant from our trainings at Hampstead and the Hanna Perkins Center in Cleveland (then the only other analytic training in the world within a center that had both a clinic and a psychoanalytic school).

We wanted it to be grounded in practical analytic thinking, to encompass multiple applications (clinical, educational, social, therapeutic), to be low-cost, accessible from many geographic locations, make use of the expertise of teachers everywhere, and have the course content spring from the current experience of the students. It was a distance training, with periodic in-person gatherings built in. We framed the seminars around attendance at staff meetings at one of the APS schools and used that material to generate an emergent curriculum. That is, readings and topic areas were not part of a pre-determined syllabus, but grew out of the discussions of development, behavior, symptomatology, meanings, interventions, treatment techniques and so forth in the actual weekly following of children of different ages attending a therapeutic school.

Students in NewCAPT were helped by their mentors/supervisors (drawn from around the country) to find and develop cases in their own locales, as well as making their own arrangements for personal analysis. There were to be writing assignments and discussions of projects following particular interests of the students, with a view to their further professional development.

We were able to sustain the pilot for two years (of the originally-planned 4-year structure), after which changes in the school situation and in the lives of our first cohort of students made it difficult to continue. It also seems clear in hindsight that we were a bit ahead of our time in constructing a distance training program, before the rest of the psychoanalytic world began even to consider this a viable possibility.3

Currently, I teach and supervise nationally and internationally, online and by phone. The work seems to me to draw on all the elements of my original trainings, as well as all the learning from students and colleagues that continues every day and every week.

If psychoanalysis is to survive, we need psychoanalytic education that both returns to its philosophical, social, political, and clinical roots and embraces new needs, new movements of people, new technologies, and the wealth of resources in the psychoanalytic world and its allied fields.