The Philadelphia Association for Psychoanalysis held a special meeting on March 14, 1981 to discuss the issue of training for clinical practice of nonmedical candidates in Psychoanalytic Institutes, embodied in the Calder Report, which has been under discussion in the Executive Council and the Board of Professional Standards. The following is a summary, adapted from one prepared by Franklin G. Maleson, M.D., of the arguments, pro and con, advanced regarding the proposal to conduct such training. It is presented here as a stimulus for thoughtful consideration of the issue by the membership and as a companion to the Point of View essay by Dr. Michels.
Arguments for Proposal 1) Current restrictions exclude a number of potentially valuable individuals whose backgrounds in clinical psychology include substantial experience in care-taking, science, and the humanities. Such experience is equivalent to those features of medical-psychiatric training that are conducive to effective analytic work. Moreover, many students in the medical track lack the broad scholarly and humanistic interests desirable for psychoanalytic training. 2) In practice, our work is primarily based upon psychological and social expertise. There is not a close, inevitable association between psychodynamic issues and biology. The conscientious nonmedical analyst can be trained to recognize and appropriately refer clinical problems with organic medical implications. | Arguments against Proposal 1) Medical training provides indispensable, irreplaceable elements, especially:
2) The excellent diagnostic and clinical capabilities of the small number of nonmedical analysts now in the American Psychoanalytic Association would not be shared by a larger, less exceptional group. To exemplify one danger, they might delay or neglect important medical consultations when indicated. |
Arguments for Proposal 1) Strict selection standards and tight controls can be maintained, so that the Association would not be inundated by nonmedical graduates or significantly changed in character. The intent and emphasis of the proposal is on increasing quality, not quantity, by permitting the inclusion of highly qualified people who might otherwise obtain inferior pychoanalytic training through other, increasingly available channels. 2) Psychoanalytic institutes will maintain their medical identification, since large numbers of nonphysicians are not anticipated. Moreover, an exclusivity based primarily on guild concerns may work against the maintenance of high quality in institutes. 3) The suggested limit for nonmedical candidates of one third of the total enrollment of an institute is merely a tentative suggestion of an upper limit and may be set lower. 4) Legal counsel has advised that the risk of challenge based upon exclusionary practices is minimal. | Arguments against Proposal 1) The original ideals of the Subcommittee will likely be eroded by unpredictable shifts in the national political and legal climate, coupled with gradual changes in the membership of the American Psychoanalytic Association's monitoring bodies. Maintenance of strict high standards will be uncertain at best. 2) Increasing inevitable challenges to medical leadership will jeopardize the medical identification of institutes. These issues will be especially difficult to discuss, once nonmedical analysts participate in ongoing institute deliberations. 3) The one-third proposed upper limit is too large. |
Arguments for Proposal 1) Since only a relatively small number of nonmedical analysts would be trained, there should be no dearth of medical analyst role models for medical students and psychiatric residents. Economic disparities with other medical specialties may be a more potent factor in discouraging psychiatric and psychoanalytic career choices. Even so, individual institutes closely affiliated with medical schools may choose to accept even fewer nonmedical applicants to avoid problems. Moreover, since Ph.D.'s teaching basic sciences are often highly regarded by medical students, the possession of an M.D. does not seem indispensable to an adequate and appealing role model. Conversely, many of the current medical models available to students and residents are technically oriented and cold, while many psychologists are exposed to models who possess traits more congenial to psychoanalysis. 2) Not every analyst must be an expert in biology. Those who are will continue to exercise their integrative influences. Those who are not (including qualified psychologists) offer other dimensions of understanding. 3) Implementation of the proposal cannot be seen as permitting encroachment by unqualified practitioners on any medical domain, because unqualified people will not be given our imprimatur. Rather, it reflects a position that those with suitable educational prerequisites and personal qualities can be properly trained in psychoanalysis under the aegis of the American Psychoanalytic Association. | Arguments against Proposal 1) Solid medical analyst role models are essential to encouraging medical students to enter psychiatry and residents to enter analytic training. High visibility of nonmedical analysts in medical settings may dissuade potentially qualified candidates, a threat particularly grave at a time of declining student interest in psychiatry. At stake is the continued viability of psychoanalysis as a medical discipline. Implementation of the proposal will widen the breach between psychoanalysis and psychiatry. |
4) Any specific fraction may be subject to legal challenge based on quota practices. Even without quotas, definitions of acceptance standards for nonmedical applicants are difficult to formulate (especially when compared to those for medical applicants) and may be challenged legally.
2) The unique ability of the medical analyst to counter one-sided, biological, symptom-oriented trends in psychiatry will be jeopardized by a weakened medical identification throughout medicine. Psychoanalysts have a responsibility to integrate biological advances into a context of psychic conflict and development.
3) Many branches of medicine are attempting to reverse detrimental encroachments upon traditional domains. Our movement in the opposite direction will damage our credibility and encourage nonpsychiatric physicians to refer psychological problems to nonmedical psychotherapists. The intensive public relations efforts of nonmedical groups will accentuate this trend, with important economic ramifications.