I am in favor of the training of nonphysicians for the practice of psychoanalysis in institutes of the American Psychoanalytic Association. My judgment in this has been influenced chiefly by two considerations; the first is more important than the second. The first consideration is both an ethical and practical one: The American Psychoanalytic Association could and should provide a public service by training qualified nonphysicians for the private practice of psychoanalysis —for their benefit and for the benefit of those they analyze. The second consideration is that the training of nonphysicians has already proved successful in those institutes of the International Psychoanalytical Association where it has been tried (which means almost everywhere but the United States).
At the most recent meeting of the Association in Philadelphia, several discussants observed that the core question of this topic is whether or not the American Psychoanalytic Association should maintain a medical identity. I would suggest two other possible core questions. First, what will be of value to the largest number of individuals — analysts, analytic patients, psychoanalytic trainees, and the community at
large? The second core question seems to me to be a variant of the first: What is best for the long range future of the science and profession of psychoanalysis? I believe that what is best for psychoanalysis over the long range will be determined primarily by a combination of our pursuit of excellence and our respect for others; this will be demonstrated most particularly by our training of the most able qualified individuals, physicians and nonphysicians alike, rather than by our identity as physicians.
I share the view of most members of our Association that the accredited institutes of the American now provide the best analytic training available in this country. Currently those nonphysicians who want to train for the practice of psychoanalysis are forced to seek training either by moving abroad or by enrolling in institutes in this country considered by themselves and others to be inferior to the institutes of the American. We could share our wealth. It would be easy to add a considerable number of nonmedical candidates to our training programs without impairing their quality. By doing so we would be providing a valuable public service, and, referring to my first core question, we could be doing something of value for the largest number of individuals. Such a sharing appeals to our own sense of fairness and thereby bolsters our own self respect.
There is another aspect of this that is important but rarely discussed. We are surrounded by nonmedical psychoanalysts who have demonstrated their clinical competence as well as their knowledge of and contributions to the science of psychoanalysis. Yet many (if not most) nonmedical analysts—whether trained by ourselves or others—sense that they are treated as second class citizens by members of the American Psychoanalytic Association. There is ample evidence to support their view. Ultimately we pay the price for the discrepancy between the competence of these nonphysician analysts and our less than generous attitudes towards them. To outsiders we appear to be insensitive, parochial, shortsighted, and unfair. The quality of our human relations is questioned and the therapeutic value of psychoanalysis as a treatment for undesirable character traits cast in doubt.
My views about these issues are not based exclusively on ethics. I believe that the public image of analysts, especially how we behave in groups, affects us in important ways. Psychoanalysis does not have a good public image at present. Much of this we have earned. As an instance, our outcome studies are infrequent and of little substance. The general public is forced to measure the results of psychoanalytic treatment to a considerable extent by how we analysts behave. Accordingly, how we treat others, such as nonphysician analysts or potential analysts, has practical as well as ethical implications. If we exclude qualified individuals from improving their services to the community for what appears to be our defensive and self-serving reasons, we may alienate individuals who could benefit from psychoanalysis as therapy or could learn and use the concepts of psychoanalysis in other fields, as well as those who might become practicing psychoanalysts.
The second consideration that has influenced me in favor of our institutes training nonphysicians stems from several discussions of the topic that I have had with psychoanalysts from other countries, most particularly with those knowledgeable about training at the British Institute of Psychoanalysis. With such individuals as Pearl King, Moses Laufer, Adam Limentani, and Joesph Sandler, I have described the reservations expressed by individuals and institutes of the American, including those reported by the committees that studied the issue. Although I also described the benefits we hoped to achieve by training nonphysicians, my greatest interest was in learning what disadvantages they had encountered in training nonphysicians.
If we exclude qualified individuals from improving their services to the community for what appears to be our defensive and self-serving reasons, we may alienate individuals who could benefit from … learn and use … as well as practice psychoanalysis.
My British informants maintain that the disadvantages of training nonphysicians, such as extra time or study needed to prepare them for clinical work, were negligible. These colleagues are also of the opinion that physician analysts have not had to reduce fees or the number of their analytic patients because of economic competition with nonphysician analysts. And they experienced no “political” movement by nonphysicians to take over the running of the Institute from physicians.
On the other hand, these informants reported that nonphysicians were often among their best candidates, became some of their best practitioners, and, throughout their training and subsequent careers, demonstrated an admirable commitment to psychoanalysis as a science and as a profession. Additionally, the fact that the British Institute has selected and trained superior individuals from different fields has had an important influence on the community at large. This has been to the advantage of the field of psychoanalysis; out of respect for this generous and far sighted policy, individuals have been drawn to psychoanalysis for therapy or for training.
The two considerations which I have described have had a greater influence upon my conclusions regarding the training of nonphysicians than such concerns as whether or not we lose influence with the American Psychiatric Association or the American Medical Association. I see the long-range future of psychoanalysis as a science and a profession as a more important primary focus than is the nature of our identity—medical or not medical—or the future of our affiliations. Furthermore, I see us protecting the future of psychoanalysis best by our demonstrated adherence to the ideals of public service, respect for others, and the pursuit of excellence, rather than by our response to the potential advantages of such things as political power or economic benefits.