Letter from the United States

Fifty years ago in the United States psychoanalysts found it possible to, and did, imagine clinical psychoanalysis as a purely medical profession, a subspecialty of psychiatry. The American Psychoanalytic Association (APsaA), with an exclusive franchise to offer International Psychoanalytical Association (IPA)-sanctioned psychoanalytic training in the USA, along with a similar exclusive franchise to limit IPA membership in the USA, set out to establish medical control over all forms of psychotherapy (Mosher, 2006). Furthermore, the Association established a system of nationally administered certification available to graduates of APsaA Approved Training Institutes, and made obtaining this certification a strict requirement for membership in the Association, and through that, membership in the IPA.

These policies caused psychoanalysis to follow a different developmental line in the United States than in the rest of the world. They also excluded the many graduates of APsaA's own institutes (approximately one third of all ‘accredited psychoanalyst graduates’) who lacked the completed cases to take, or declined to submit to, or did not pass, APsaA's certification examination. In addition, a structure was set up within the Association, with the leadership and administrative positions dominated by Training Analysts rather than by a cross-section of Association members. These arrangements did not merely determine who could become a psychoanalyst, they set the stage for issues that APsaA is facing today by promoting the development of a variety of training programs in psychoanalysis, some excellent and some of low quality, outside the Association.

In the folklore of the Association, the medical-exclusionary posture of the Association has been attributed to such intentions as to preserve high ‘standards’ of training and practice, and at the same time to prevent entry into the field by so-called ‘quacks.’ Occasionally mentioned, but rarely examined in greater detail, are the m