Mayer: Bob, throughout your psychoanalytic career, you've been centrally involved with the issue of psychoanalytic training for people who are not M.D. 's. It's my impression that this issue looms large in the history of the San Francisco Institute as well. Tell me something about both.
Wallerstein: Well, let me start with how non-medical training became something I was specially involved in. Back in the 1950s, The American set up the Committee on Training for Research (CTR), and when I first became a member of The American in 1960, I was invited to join that Committee on the basis of my own work in psychoanalytic research. At the time, they were working out the rules which would permit training for a select number of “established scholars” whose work would be enhanced by psychoanalytic training and whose scholarly endeavors would in turn contribute to the development of psychoanalysis. These were remarkable people we were considering—George Klein, Don Spence, Leo Goldberger, etc. Mostly people around the original Rapaport group. I became chair of CTR soon after being appointed to the Committee and remained chair until I became president of The American in 1971, so I really was very involved with that first generation. They came through at the rate of three, four, five, maybe six per year, which of course undermined what was then the common protest that this could become a back door for training floods of non-medical applicants. By the way, there were lots of misconceptions about that program, some of which still survive. For example, there was never a requirement that these scholars would abstain from clinical work or sign something to the effect that they wouldn't practice analysis. They simply committed to maintaining their scholarly work and to doing as much analysis as would appropriately support that work. The arrangement was entirely self-monitored. It was true that there were a couple of individual institutes—I think it was only two, and the New York was one of them—that asked people to sign a statement that they wouldn't engage in analytic practice independent of their scholarly work. But such a statement was never required by The American, and it was the exception.
Mayer: And CTR continued for the purpose of training these “established scholars” only?
Wallerstein: Well, gradually CTR expanded to accept younger people of promise as well. I felt that was very important. And then, after I left the Committee, it expanded to include people with special backgrounds in teaching or other areas where psychoanalysis might be influential, and CTR became CORST, the Committee on Research and Special Training, which we still have today.
Mayer: But by that time you had come from Topeka to San Francisco, where you'd started the Doctor of Mental Health Program. I gather San Francisco was a welcoming climate in terms of nonmedical training.
Wallerstein: It definitely was. The San Francisco Institute had expressed great interest in non-medical analytic training from the very beginning. In fact, it's hard to understand what's happened with non-medical training in this country without some history which centrally involved San Francisco, so let me summarize a little of that. As you know, the 1938 Rule established that The American would have total autonomy within the IPA regarding training requirements, as well as an exclusive franchise on IPA-approved psychoanalytic training within the United States. So The American was given authority to choose to train only those with medical degrees, and nobody in the U.S. could enter the IPA unless they had trained under the auspices of The American. This was what the Americans wanted, and though it was never formally voted upon at the ‘38 Congress, it was discussed and put off for the final decision until the next Congress in 1940. Well, the 1940 Congress never happened because of the War; there wasn't another Congress until 1949. Even by 1938, though, many, many European analysts had immigrated to the U.S., and Americans had suddenly come to constitute a majority of the IPA. Without the autonomy and exclusive franchise declared in the '38 Rule, the Americans had threatened to secede from the IPA. If they had, the IPA probably would have collapsed; so, right after the war, an arrangement was worked out with the help of Anna Freud and Ernest Jones. In essence, the ‘38 Rule was taken for granted, as though it had been formally passed, and from ‘38 until the mid-fifties there was no non-medical clinical training under the auspices of The American.
Mayer: Yet some American non-medical analysts continued to be trained?
Wallerstein: Absolutely. For example, IPTAR and the Freudian Society in New York were early groups formed to train non-medical analysts, and the people doing the training at those institutes were mostly members of The American—some of them, in fact, were among the real pillars of The American. Eventually, of course, those groups went on to train their own.
In the meantime, though—and here's where San Francisco came in—there were a number of non-medical training analysts in this country who, because they hadn't graduated before 1938, were not allowed to become members of The American. There weren't many—maybe 20—but they were an important group. And one of them was in San Francisco: Anna Maenchen. In addition, there were two other significant non-medical figures in San Francisco: Erik Erikson and Siegfried Bernfeld. Those three were half of the original training group in San Francisco, along with three M.D.s: Berliner, Macfarlane, and Windholz. There developed a sort of crusade to establish a membership category for non-M.D. training analysts, and Stan Goodman, along with Vic Calef, both from San Francisco—they were very involved in that. In fact, it was known informally as the San Francisco Proposal. It finally passed in 1971; I was president of The American at the time. Incidentally, that I got elected still strikes me as surprising. I had consistently espoused unpopular positions since becoming a member, especially on this issue of nonmedical training. I was known really just for two things—reading waiver requests for nonmedical training as chair of the Committee on Training for Research, as well as for my psychotherapy research. Anyway, I did get elected in 1970.
Mayer: And by that time you were at Mount “Lion.
Wallerstein: Yes, I'd come to San Francisco to be chief of the Mount Zion Psychiatry Department, and it was a very exciting time. The Department was a model for interdisciplinary training. Norm Reider and Ed Weinshel had really set the concepts in place with extremely strong—in fact, crucial—help from Shirley Cooper, who was head of Social Work. It was an ideal setting in which to experiment with the kinds of ideas Larry Kubie had talked about in terms of a Doctorate of Medical Psychology. In 1963, a conference had been called to discuss those ideas at Gould House in New York. About thirty of us attended, representing psychoanalysis, psychiatry, psychology, and social work, to talk out the pros and cons. I was asked to give a position paper on research training, and Bob Holt edited all the papers into New Horizons for Psychotherapy. That really became the blueprint for the DMH program.
Mayer: What sort of support did you experience from The American? Were there many others besides you and Kubie who were excited about it?
Wallerstein: There was a cadre. George Pollock was one very strong supporter, as well as many here in San Francisco. But, in general, I think people felt “there goes Bob
again.” And yet, you know, even then, it was changing. I represented a tiny minority in 1960, but it very gradually was to become the feeling of the majority, that it just didn't make sense to keep psychoanalytic training a medical specialty.
Mayer: The DMH program was really a very strong vision and you trained a remarkable group of people in your nine classes of graduates, even though the program didn't survive past the mid-eighties. Did it have an impact beyond giving us a small but fine generation of clinicians?
Wallerstein: Outside this country, it did, probably even more than in the U.S. In France, Andre Green was especially interested, as was Laplanche. There was an article in Le Monde about the possibility of developing a similar program in France. By the mid-seventies the tide had really turned in the U.S., and even the Psychiatry Departments that had been most interested in starting similar programs were going in other directions. Of course, I had always been concerned that the DMH graduates should be eligible for training through The American. That didn't become possible until '86, though one of our graduates had been accepted earlier as a research candidate. But a number of DMH graduates have recently started analytic training under the Gaskill amendment, so I think we'll start to see them joining The American and bringing their talents.
Mayer: The link between the DMH program and psychoanalysis was, as I understand it, very much via Mount Zion. I suppose the continuing climate of support for non-medical training at the San Francisco Institute, especially from the Education Committee, was also a function of how closely connected Mount Zion and the Institute were for many years.
Wallerstein: I think there's no question about that. Norm Reider started the department at Mount Zion out of his vest pocket and non-medical people were crucial from the start. Erik Erikson was very involved at the outset. Then he left the Bay Area when he refused to sign the loyalty oath at the University of California back in the fifties, but I invited him back once I became chief in 1966. And while I was chief, half the Education Committee of the Institute was on the staff at Mount Zion, training as many social workers and psychologists as psychiatric residents. We all had the chance to see how well that kind of interdisciplinary program could work. Faced with the loss of traditional training grants, I undertook to implement the ideas of the Gould Conference with the DMH program. A lot of the Mount Zion staff were important in setting it up, and there was support from those who weren't actively designing the program as well. For example, Vic Calef had always advocated teaching people to be first and foremost psychoanalysts—not psychiatrists or psychologists who secondarily became psychoanalysts. He actually had hoped that something like the DMH program would in itself become an analytic training program.
Mayer: I remember his talking about how exciting that could be; to select fine people, just out of college, and be able to graduate analysts who were still in their twenties.
Wallerstein: Exactly. Anyway, in addition to that ongoing influence from Mount Zion which the San Francisco Institute had, there as the continuing influence of some very fine European-trained non-medical teachers like Bernfeld.
Mayer: And then, Bob, the most recent phase of the story: your tenure as president of the IPA and the really landmark changes that have come about with regard to non-medical training in the last five years. Tell me about that.
Wallerstein: Again, we have to go back historically to see those changes in proper perspective. I mentioned the ‘71 amendment that gave non-medical training analysts membership in The American, which Stan Goodman and the San Francisco group had been so instrumental in. Not long after that amendment passed, Ed Weinshel became Chairman of the Board on Professional Standards and he set in place the first official action of The American to admit non-medical applicants. From that first move through what has now become the Gaskill Amendment, his role has been enormously important in the whole process. Anyway, in 1974 he appointed a committee of The American under Homer Curtis's leadership to discuss non-medical applications beyond that first self-limited group of non-medical training analysts. They studied what qualifications should be required and what the mechanisms might be. The idea was to open the door to non-medical training while still maintaining strong links to medicine. That committee went through several incarnations and finally the fourth successive committee dealing with this issue put forth a proposal at the 1984 May meetings in San Diego, which was voted down. It was in fact a compromise proposal which didn't really satisfy anyone, but meantime, Division 39 of the American Psychological Association was becoming increasingly active and impatient with the deliberations of The American on this issue. Our own Education Committee in San Francisco was really dismayed at the lack of progress as well. Several of us from San Francisco immediately made it our top priority to keep the issue alive and active within The American's Executive Council. So, at the next December meetings, still in ‘84, a delegation of us prevailed upon the Executive Committee to create a new committee which Herb Gaskill was appointed to head that would start afresh to design a new policy for The American. His work was proceeding, but in spring of ‘85, Bryant Welch and the others sued both The American and the IPA on an anti-trust action.
Mayer: And you became president of the IPA right around then.
Wallerstein: Yes. It was a tricky situation. It was The American's turn for the presidency; Adam Limantani, a European, was just ending his tenure. The IPA wanted, of course, to settle the suit since almost every component organization of the IPA included non-M.D.s, and the IPA had always supported the idea of non-medical training. They felt it wasn't really their fight. On the other hand, there was the total autonomy provision of the '38 rule which implicitly gave IPA support to The American's standards.
Anyway, there was real concern about a possible conflict of interest between my role as president of the IPA and my long history of involvement with The American. One suggestion was that I appoint a European secretary. This would have been a major break with tradition; secretaries had always been the personal choice of the president, from the same region and, in fact, usually from the same city. I had hoped to appoint Ed Weinshel. We did eventually work it out so I could do that and it turned out very much for the best, not just for me but for the IPA as well. Ed understood the workings of The American as well as of the IPA, and people within both organizations trusted and respected him enormously. He also was deeply committed to working out a viable way to train non-M.D.s within The American without tearing it apart. Of course, he'd been the one who'd invited me to Mount Zion in the first place, and he was very, very central to the interdisciplinary ideal of training there. So those were two years of tough but ultimately very productive negotiation. We finally reached a settlement which involved giving up The American's exclusive franchise on IPA-approved training within the U.S., as well as agreeing that The American would pick up 60 percent of the IPA's legal expenses, based on the fact that more than 60 percent of the worldwide IPA membership outside the United States was unwilling to have their dues used to support The American's fight in the lawsuit. And then, of course, by that time the Gaskill Amendment had passed, so another doorway, within The American, had opened for non-medical training in the U.S.
Mayer: It's been quite a history, Bob, and you and your ideals have been central to it—especially to creating an open and lively environment for the future. We in San Francisco have, I think, a special gratitude to you for the direct and personal impact you've had on psychoanalysis locally, as well as on many of us individually. Thank you.