After a rigorous review, the International Psycho-Analytical Association approved three US nonmedical training institutes as “provisional societies” during the 36th IPA Congress in Rome last August. The three new member institutes are the Institute for Psychoanalytic Training and Research (IPTAR), the New York Freudian Society, and the Psychoanalytic Center of California Professor Charles Hanly of Toronto, who chairs the IPA Committee on New US Groups, acclaimed the excellence of these institutes. Two other institutes are also being evaluated.
The institutes participated in an exhaustive review process wherein all aspects of training and practice, as well as criteria for candidate selection and graduation and for appointment of training analysts, were reviewed by site visit committees of the IPA
The review included both institutes and membership. As part of the site visit responsibility, each training analyst—including very senior people—had to be reviewed for IPA confirmation of the training analyst status, and the credentials of everyone who desired IPA membership had to be similarly reviewed. Procedures had to be developed in the process of the relationship with the various institutes. Site visitors interviewed in detail the leadership of each institute; they examined a broad array of institute documents; they sat in on classes, supervisions, and all institute committee meetings. In addition, a format of informal clinical discussion groups was developed to provide a means of assessing the clinical sophistication and competence of the individual training analysts.
At the completion of their work, the site visit committees reported to the Committee on New US Groups, which then recommended to the Executive Council of the IPA that the three institutes be accepted as provisional societies. The final decision was made at the Business Meeting at the Rome Congress, where the recommendations were unanimously approved and the new members and institutes were welcomed into the IPA with a standing ovation.
According to Professor Hanly, inquiries were initially received from approximately 30 groups in the United States seeking information about affiliation with the IPA In addition to the five that either have been approved for provisional membership or are currently under review, one withdrew from consideration before scheduled site visits began and two others explored the requirements for qualification but did not pursue the application. The remaining groups made no contact with the Committee on New U.S. Groups after their initial inquiry.
“Provisional society” status grants these institutes all rights within the IPA during a period of provisional membership. Site visit committees will continue a liaison function with the provisional societies until they become full component societies, a process that ordinarily requires a number of years. Meanwhile, however, individual members of the institutes have full membership in the IPA
Freud's group early attracted people who were not trained in medicine but who were interested in psychoanalysis and became trained in the new technique. By the turn of the century, Freud had welcomed more and more of these “lay analysts,” who had, from the beginning, made important contributions and become an integral part of his circle. Some of them—like Theodore Reik and Ernst Kris—lived in Vienna; others came from the world over to visit and study with Freud, later returning home to practice.
The rise of Nazism saw a general exodus of psychoanalysts from Europe—Freud himself escaped to London; many others emigrated to the United States. By 1933, the Berlin Society had already been dissolved; by 1939, the center of action for psychoanalysis had shifted away from Vienna and Berlin across the Atlantic to the eastern seaboard of the United States, primarily New York.
US institutes on the whole did not welcome these immigrants. Not only were the institutes committed to the training of psychiatrists, but American analysts likely felt that their economic futures were jeopardized by the stream of Europeans. Some of the lay analysts were invited to joint institutes, but most had difficulty finding gainful employment, and many were both denied membership in the institutes and forbidden to practice analysis. Thus, groups of disenfranchised European lay analysts, seeking to
establish themselves against the tide of the American establishment, congregated largely in the port cities of the East. Some few gathered elsewhere—Chicago, Los Angeles, San Francisco.
The war also acted in other ways to increase the numbers of persons interested in analysis. Many psychiatrists returning home from war applied to institutes for training; in addition, the GI bill enabled large numbers of returning servicemen to go on to higher education, and an explosive increase in clinical psychologists ensued. Those psychologists who were interested in psychoanalytic training found themselves barred from admission to US training institutes and from receiving training analysis or psychoanalytic supervision from members of the APA.
In New York, amid this ferment and frustration, there was also the galvanizing influence of Theodore Reik. One of Freud's group, Reik had come to New York from Holland under the threat of German invasion. Expecting to be received in America with the psychoanalytic equivalent of a brass band, according to Joseph Natterson in Psychoanalytic Pioneers (ed. F. Alexander, Basic Books, 1966), Reik instead was met by a delegation of the New York Psychoanalytic Institute, which forbade him to practice psychoanalysis. As Natterson puts it Reik was virtually “paranoid in response to the rejection by his psychoanalytic colleagues in America.” Although Reik was later briefly permitted to teach, he resigned under a cloud and became a training analyst at the William Alanson White Institute. Later, Reik became the focus of a cluster of nonmedical aspirants to analytic training, and this group founded the National Psychological Association for Psychoanalysis (NPAP) by 1948. Prior to the founding of NPAP, nonmedical analysts had been able to receive training only in rare instances of sponsorship by an institute of the APA for training abroad or by privately arranged “apprenticeship” training from the European lay analysts or from members of the APA in defiance of APA rules.
Founded with the mission of training analysts who were otherwise ineligible to be trained, the orientation of NPAP was from the beginning eclectic and inclusive. Over the years, this resulted in an uneasy amalgam of persons of various theoretical and technical convictions—Jungians, Adlerians, Sullivanians—and Freudian training became increasingly difficult to obtain. Two study groups evolved of persons interested in securing systematic classical Freudian training. These eventually split away, and in about 1959 one of these was incorporated as IPTAR, and the other became the Freudian Society.
IPTAR comprises a small (73 full members) group of primarily clinical psychologists and social workers devoted to the most stringent standards for classical psychoanalytic training and research.
The training program is open to persons in the fields of psychology, social work, medicine, psychiatric nursing, psychiatry, counseling, and the clergy. Candidates undergo extensive evaluation for admission and ongoing evaluation during the training process. They must pass a Matriculation interview at the end of the first year of training. Readiness for Control examinations, both written and oral, occur at the end of the second year of training.
Two control cases are required—both must be seen four times weekly, one for a minimum of three years and the other for at least two years. The first should show signs of a classical neurosis or a narcissistic character disturbance. The second may have a diagnosis of borderline and require the use of parameters. In both cases, the patient must be able to participate in the psychoanalytic process, classically conceived. The major case is presented in written form after three years of supervised analysis, and the candidate then presents the case orally to a committee of three fellows. The final graduation interview evaluates the candidate's ability to function independently as an analyst.
To qualify for graduation, a candidate must have completed the four years of didactic training, must have completed the requirement for supervised analyses, must have had his case presentations accepted, and must have made satisfactory progress in his training analysis. (All training analyses must be conducted four times weekly.)
The curriculum is described as a “coordinated curriculum for the study of classical theory and technique and their expansion as a result of recent developments.” The first year comprises the basic study of Freudian theory and the developmental perspective; the second year, the psychoanalytic theory of psychopathology and the criteria for analyzability; the third year, which begins the control case level of the curriculum, focuses on psychoanalytic treatment in the normative situation and its modification for various diagnostic groups; the fourth year is devoted entirely to the clinical process in depth, including continuous case seminars, the dream seminar, and so on. After the fourth year, electives are offered that address various other aspects of psychoanalytic thought such as humanistic Freud and the critique of civilization.
Only fellows of the IPTAR Society may serve as training analysts. Five years after election to full membership, a member may be recommended by two fellows for fellowship consideration.
A larger group that like IPTAR, also evolved out of a desire for rigorous standards for classical psychoanalytic training, the Freudian Society comprises psychologists, social workers, and about a dozen psychiatrists among its 155 full members.
The Training Institute accepts applicants holding a Master's or higher degree in psychology, social work, medicine, psychiatric nursing, or other appropriate fields of study. Certificates are awarded in two programs: Adult Analysis and Child and Adolescent Analysis, which may be taken individually or together.
For the Adult Analysis program, the first two years are occupied with basic seminars consisting of an introduction to psychoanalytic theory, psychopathology, developmental theory, and the theory of technique.
Candidates must pass a Readiness for Control Evaluation before proceeding to the control analysis seminars, which constitute the second two years' work. The latter deal with the further extension of basic theory and technique and with more advanced theoretical and technical material, including case presentations. Two supervised cases are required: one must be in treatment for a minimum of one year; and the second, for a minimum of two years. Each case must be under the supervision of a different training analyst The cases must be analytic and must be treated four times weekly.
For the Child and Adolescent program, five years of course work are required as well as the supervised analysis of two child or adolescent cases seen four times
weekly, one for a minimum of one year and the other for a minimum of two years. A number of the faculty members in this program were trained at the Hampstead Child Study Clinic.
At the conclusion of training, the candidate must present a case before a Case Presentation Committee and demonstrate his grasp of theory, general competence, and adequate mastery of countertransference issues. Graduates of the program are eligible to become associate members of the society and may be invited to full membership after a year.
The procedure for selecting training and supervisory analysts at the Freudian society was changed to conform to the requirements of the IPA Five years after election to full membership, a member may apply to the Training and Supervising Analyst Selection Committee by submitting a detailed curriculum vitae and the particulars of his analytic practice and experience. An in-depth case presentation to five members of the committee is central to the procedure.
Historically devoted to the expansion of psychoanalysis throughout the country, the Freudian Society offers to assist mental health practitioners outside New York City to establish Freudian training programs in their own communities. In 1985, the Freudian Society established a training Institute in Washington, DC, for a group of Washington-area candidates. The first class is now nearing completion of training, and the second class is in the Readiness-for-Control phase. The Society is seeking candidates for a third class to matriculate in September 1990. For this program, faculty members commute to Washington on alternate weekends to conduct marathon training sessions; total class hours are equal to the training classes in New York. The Washington candidates receive their training analysis and supervision from training analysts of APA institutes who have become members of the Freudian Society.
The Society of the PCC was formed in 1984 to provide for the needs of the faculty, candidates, and eventual graduates of the psychoanalytic training program of the California Graduate Institute (a free-standing school of professional psychology). Three years later, the training institute of the PCC was formed when large groups of faculty members and candidates split away from CGI to form this new institute dedicated to expanding psychoanalysis in all mental health fields and designed in accordance with the requirements and guidelines for training institutes of the IPA In addition to the specific desire to train highly qualified individuals from the broadest spectrum of fields, the PCC has a special interest in exploring treatment modalities that go beyond those for the classical neuroses, to research into and treatment of primitive mental states, including narcissistic, borderline, autistic, and psychotic states.
The PCC awards three certificates upon completion of its training programs; a Certificate in Psychoanalysis is awarded to candidates who are licensed in a mental health field; a Certificate in Research Psychoanalysis is awarded to candidates who hold a PhD degree or its equivalent and who have a professional interest in psychoanalysis as an adjunct to teaching, training, or research; and a Certificate in Child Psychoanalysis will be awarded to candidates or graduates of either of the other certificate programs who complete an additional program of study and supervised casework with children. An additional track awarding a PhD degree in psychoanalysis is being developed in conjunction with the certificate programs. Research candidates must complete a field placement internship in a mental health facility approved by PCC. Among their three required control cases, all students are encouraged to treat one person with a diagnosis of a primitive mental state. All candidates for graduation must write a thesis and pass an oral examination.
An innovation of the training program is an emphasis on infant observation, which occupies half of the first year's curriculum. Freudian theory is taught throughout the first year; the second year includes Klein, ego psychology, the “Middle School,” personality development and theory of technique; the third year covers Bion, self psychology, and psychoses, in addition to case conferences; the fourth year includes the study of perversions and psychosomatic disorders, trauma and narcissism, and child psychoanalysis, in addition to case conferences. After the fourth year, other seminars will be offered.
The PCC's current membership comprises 39 full members, of whom 13 are training analysts and 37 candidates from the fields of medicine, art, psychology, nursing, social work, literature, history, counseling, and teaching. Three candidates are pursuing research certificates, while none has yet begun child training. Some members of this institute are also members of APA institutes in Los Angeles.
No one knows yet what effect the IPA decisions will have on American psychoanalysis. According to the officers and members of these new institutes who were in Rome, nonmedical analysts in the United States have long been treated as unwelcome intruders into psychoanalytic practice by members of the American. Furthermore, they assert that the APA over its history has systematically blocked opportunities for nonmedical applicants to train, receive supervision, or receive training analysis in the mainstream of American psychoanalysis. Thus a large group of nonmedically trained people interested in and committed to psychoanalysis, but who could not be trained in established institutes, were forced to develop their own pathways for training and collegiality. They have always looked to the IPA and to the APA for guidelines and models.
Certainly, these institutes would long ago have been member societies of the IPA had they been located anywhere else in the world. Certainly, too, the pressures from nonmedical applicants, including the lawsuit by the psychologists, have contributed to the widening door of the APA (CORST, CNMCT, the expansion of selection criteria, the push for a by-law change to train nonmedical analysts). The nonmedical institutes are secure and confident of their training programs. Nevertheless, some within the nonmedical institutes fear that if APA strictures loosen, APA institutes may skim off the best qualified applicants, leaving the less qualified for their applicant pools. Others denounce the devaluation of nonmedical institute training that is implicit in this fear. Some feel that the wider acceptance of nonmedical analysts within the APA will enhance the stature of lay analysts across the board.
Some within the APA believe that the stature and prestige of American analysis have been achieved by the maintenance
of rigorous admission standards, including the requirement for psychiatric training, a standard they prefer not to liberalize. Others feel that the best solution would be to have IPA-approved institutes for the training of medical analysis alongside IPA-approved institutes for the training of psychologists and qualified others. Still others deplore the waste of scant resources resulting from unnecessary duplication of efforts. Yet others warn against a “changing world” in which medical institutes may be left behind in an obstinate effort to “preserve standards,” when what is required is a creative and generative turn to the world.
The officers of the new member institutes support rigorous and thorough training. They recognize the advantage of affiliation with an umbrella organization that will legitimate their standing in the international community of psychoanalysts and will involve them in worldwide efforts to achieve the highest standards for practice and training.
Stephen M. Sonnenberg, Chairman of the APA's Committee on Public Information, asserts that psychoanalysts must not look only to psychiatry for practitioners who understand and offer broad support to psychoanalysis. Of his work with the Washington training group of the Freudian Society, he says, “These are people who think as we do—they have the same values, knowledge, skills, and goals; and they are filled with interest and enthusiasm.” He feels that these new colleagues are powerful supporters of the psychoanalytic movement and will enrich “the analytic lives of everyone” within the APA
This story was developed with the unstinting generosity in time and effort of the following people: Charles Hanly of the IPA; Doris Bernstein,* Norbert Freedman, Stanley Grand, and Louis Lauro of IPTAR; Helen Gediman, Jeffrey Golland, William Greenstade, Moss Rawn, and Joseph Reppen of the Freudian Society; and James Gooch and Shirley Gooch of the Psychoanalytic Center of California In addition, Gail Reed generously provided detailed accounts of the history of nonmedical training in New York.
* Doris Bernstein, Past President of IPTAR, died on January 19, 1990, shortly before publication of this article.