Doctors of psychology, mental health, and social work are now fully eligible for psychoanalytic training and membership in the American Psychoanalytic Association on the same basis as psychiatrists, and many institutes will begin enrolling such candidates this fall without the waivers from the national body that were previously required.
The by-law amendments authorizing this change were approved by the members of the association by a comfortable margin, 771 to 146 with two abstentions; 612 affirmative yes votes were needed for adoption. This move is the culmination of a long process and marks a fundamental change in American psychoanalysis. Though psychoanalysis in other parts of the world has been practiced by physicians as well as members of other professions, it has, until now, been a basic principle of The American to restrict (with only a few carefully regulated exceptions) eligibility to physicians.
Limiting the practice of analysis to physicians was a principle proposed and debated within this association shortly after its founding in 1911, and it was firmly in place 10 years later. Freud summarized the reasons in 1927, when he said, “[American analysts] see how in their own country lay analysts put analysis to all kinds of mischievous and illegitimate purposes. It is not to be wondered at if in their indignation they give the widest possible berth to such unscrupulous mischief-makers and try to prevent any layman from having a share in analysis” (SE, Vol. 20, p. 258). Freud opposed this decision, however, on the grounds that medical and psychiatric training were not necessarily the best preparation for psychoanalytic practice and that if lay analysts “were offered as an inducement the possibility of receiving the approval of the medical profession and of being invited to co-operate, might they not have some interest in raising their own ethical and intellectual level?” (p. 258). Freud's argument was firmly rejected, and full-scale reconsideration of the decision was not undertaken until 1975.
Much earlier, an exception had been made for nonmedical analysts trained in the Topeka Institute on the grounds that the remoteness of the Menninger Clinic made it difficult to attract highly qualified analysts from elsewhere. In the late 50's, a further exception was made for nonmedical candidates with special interest and qualifications in research. The Committee on Research and Special Training screened these applicants and probably served as a model for the work of the Committee on Non-Medical Clinical Training, which came into being almost 30 years later. The major contributions of nonmedical analysts trained under these two exceptions, as well as those of others trained in other parts of the world, led to concern that The American might be overlooking important sources of new members of the profession. Consequently, in 1975 a Committee on Prerequisites for Training was appointed to study the nature of the educational and professional experiences that would be the best preparation for analytic training.
The committee studied the question for five years and concluded that four kinds of preparatory experiences were essential: education in science; education in social and humanistic studies; education in clinical theory and practice, including immersion in the role of human caretaker; and socialization into a professional identity with the associated clinical and ethical standards. They decided that medical/psychiatric training was not the only path to provide these essentials. Doctoral programs in psychology and mental health were recommended as proper prerequisites for analytic training.
As a result, the Board on Professional Standards approved in principle the training of qualified nonmedical applicants.
The principle, however, was not soon put into practice and remained the center of considerable controversy. A series of other committees studied the organizational, political, and professional implications of such a change but by May 1984 had still not reached consensus on a recommendation to the membership. To resolve the impasse, in December 1984 the Executive Committee apointed an Ad Hoc Advisory Committee, with former president Herbert S. Gaskill as chair.
The committee's report, which became known as the Gaskill Proposal, was delivered in May 1985. It called for the admission of nonmedical candidates whose educational and professional achievements were approximately equivalent to those of psychiatrist candidates, and it called for the establishment of a committee of the Board to evaluate such candidates at the request of the local institutes and grant waivers to those found to be qualified. This proposal was preserved intact despite intense opposition by a minority of the Executive Council, and was approved by a two-thirds vote of the members. It was implemented under the leadership of Richard Simons, who was then president of The American; Shelley Orgel, then chairman of the Board on Professional Standards; and Carl Davis, the first chairman of the Committee on Non-Medical Training. Since that time a number of candidates have been granted waivers by the CNMCT.
While this process was going on, a new complication arose. In 1985, four psychologists brought a class-action suit against The American and the International Psychoanalytical Associations on behalf of all those who allegedly had been excluded from admission to the institutes for economic reasons in violation of antitrust laws. Much of the work of Simons's presidency was devoted to responding to that suit. The main events usually took place in closed, confidential meetings of the officers and Executive Committee with counsel, with the International Association, and with the plaintiffs. Thus, even though the suit was settled, the history of the process has remained largely private.
Speaking of those times, Simons recently said, “The Executive Committee and the Executive Council had two goals during my presidency. The first was to achieve a fair and honorable settlement of the law suit. The second was to preserve our by-laws and our right to determine the future character of our Association according to those by-laws, rather than permit those by-laws to be destroyed through legal pressures and thereby have our future imposed upon us by external forces. All of us in the American Psychoanalytic Association can take pride in the fact that both of those goals were fully realized. Though the changes in our admissions policies have been said to have been brought about by the suit, they were actually the outcome of a process that had begun long before with the establishment of the Committee on Research and Special Training in the late 1950s.”
For the past five years, the CNMCT has been approving nonmedical candidates who are now successfully pursuing their training throughout the country. This demonstration of the feasibility and desirability of expanded eligibility led to consideration of a further expansion that would recognize nonmedical applicants as eligible without case-by-case consideration, a process involving considerable effort by the applicants, the local institute, and the CNMCT. Last year, the Executive Committee, the Board on Professional Standards, and the Executive Council approved amending the by-laws further. A task force was appointed with Homer C. Curtis, a past president, as chairman to plan and implement the process. Members of the task force with special knowledge of training programs in psychology, mental health, and social work provided information and guidance, and the task force consulted the Office of Accreditation of the American Psychological Association. They concluded that people holding a Ph.D. or Psy.D. in clinical psychology from a program accredited by the American Psychological Association were eligible, but that since the Ed.D. is not a clinical degree, applicants with that degree should still be required to demonstrate clinical training and competence to the CNMCT.
The D.M.H. (Doctor of Mental Health degree) is rare. The University of California at San Francisco granted 75 of them and then discontinued the program. Five of its graduates received waivers and are currently in training. The task force determined that this program met the criteria for eligibility; so that degree was included in the amendments.
A number of candidates with M.S.W. degrees have been granted waivers on the basis of post-master's clinical courses, supervision and experience. The task force, however, recommended that the M.S.W. degree alone not be considered the equivalent of a doctor's degree, but that a social worker with a Ph.D. or D.S.W. can be assumed to have demonstrated the necessary degree of intellectual ability, perseverance, and goal-directedness. M.S.W. social workers will still be eligible for training by demonstration to the CNMCT on the basis of their post-master's degree qualifications.