Two articles appearing in TAP (26 #1) by fellow psychologists Jonathan Slavin, President of Division 39 (Psychoanalysis) of the American Psychological Association, and Barbara Stimmel of the New York Freudian Society have stimulated a good deal of thinking and debate. Although I agree with the bulk of what these authors have to say, I had strong reactions to a number of assertions made by each.
Dr. Slavin wrote of some psychologists' desire to belong to the American Psychoanalytic Association and of his fears about why this might not come to pass. He cited as an example the possibility of exclusion due to arbitrary issues of “pedigree.” On the other hand, Dr. Stimmel wrote of her perception fo the triumph of ideals over private guild interests in the informal practice of APsaA members training nonmedical analysts. She sees the psychoanalytic ego ideal as inherently democratic, a perception that seems discrepant with that of Dr. Slavin.
I wish to address myself to the themes of democracy and equality that these authors put forth in different ways. Dr. Slavin seems to imply that the training in medical and nonmedical psychoanalytic institutes is equivalent, and Dr. Stimmel implies that the ideals of psychoanalysis are at the moment nonelitist with regard to entry into and advancement within the profession. I disagree with Dr. Slavin that the training at all institutes is equivalent and with Dr. Stimmel that psychoanalysis is nonelitist.
In a 1990 article, “Authority and Identity in Psychoanalytic Training,” which appeared in Meisels and Shapiro's edited volume, Tradition and Innovation in Psychoanalytic Education (Lawrence Erlbaum Associates), Dr. Slavin writes that “anyone who has had the opportunity to examine the curricula of a broad variety of psychoanalytic institutes, both medical and nonmedical, will find that despite significant ideological differences among these Institutes, it is clear that most share a common core, generic curriculum” (p. 201). In his TAP article Dr. Slavin writes that “it would be important to know that arbitrary, ritualized, or educationally insubstantial issues will not be raised if an otherwise well-qualified institute were to seek accreditation.” Nowhere does he mention the vast differences that differentiate one institute from another with regard to training requirements. With the generic issue of pedigree, Dr. Slavin erects a straw man, behind which is hidden the fact that in order to train at an APsaA institute, a personal psychoanalysis must be undertaken at a frequency of five times a week, with four times a week as a minimum; and at least three supervisory cases in analysis must be conducted at a frequency of four to five times a week, with at least one carried to termination. To be certified by APsaA, the candidate must submit extensive written reports of these control cases.
The nonmedical institutes that were admitted to the IPA in Rome in 1989 and in Buenos Aires in 1991 have come the closest to approximating these requirements. One of the defining characteristics of a psychoanalysis is frequency of sessions, although it is not the only one and is certainly not a guarantor of analytic success. I believe that it is an essential for the survival of psychoanalysis that analysts be thoroughly analyzed and thoroughly trained and that depth not be sacrificed so that everyone can belong. Otherwise, what were once psychoanalytic institutes will become psychotherapy institutes.
Such maintenance of standards is quite costly
for candidates, which brings me to my reaction to Dr. Stimmel's article. She writes of “the essence” of psychoanalysis (in contrast to the politics adhering to it) as being cross-cultural, democratic, and non-sexist, and that “diagnosis aside, psychoanalysis treats all comers equally. In [this] way, it is democratic and bias-free.” She says she is speaking of the theory. Let me, then, address the politics and the social structure and social organizations that have emerged. Although the psychoanalytic profession has come a long way in recent years, particularly with the admission of many more women to its top echelons, it is still remiss in a number of areas—e.g., those who are analyzable but are economically disadvantaged or are from various ethnic and minority groups do not have access to those better trained in the profession. Nor do those who do not come from privileged social or cultural groups, sharing mutual interests, social networks, and the capacity to invest considerable sums in training and treatment gain entree into the profession. For those who are not part of this “in-group” there is little opportunity to partake in the informal social systems and networks that enable one to gain access to the latest information and “gossip” needed for advancement. As a woman and as a psychologist, I have had the privilege of training with the best in the field, but I am keenly aware that some portion of this privilege has resided in my ability to pay for my training, to attend professional meetings at home, in other cities, and in other countries, and to be able to distribute my writings.
Dr. Stimmel writes that “the theory is … ultimately non-sexist.” There have been in recent years great advances in the theory and some revision of Freud's more objectionable views on female development. One can only be aware, however, when one attends professional meetings, of the traditional life styles of many of the leaders of the profession. Although there are notable exceptions, in general husbands take ascendant positions over their wives, both professionally and personally. It has been gratifying in recent years to have witnessed the abolition of the practice of wives of members serving tea in the Hospitality Suite at APsaA meetings! I would like to infer from Dr. Stimmel's article that she speaks of a collective psychoanalytic “ego ideal” that hopefully will be put more and more into personal practice in the years to come.
In view of the seeming inconsistency in some of my own statements, on the one hand advocating training standards that are quite rigorous and therefore costly, and on the other advocating training opportunities for the less privileged in our society—women and minority groups—I would propose the establishment by institutes of scholarships based on need and of more low fee analysis and supervision offered, not just by candidates but by the best in the profession. I would like to see the establishment of discussion groups aimed at increasing awareness of subtle exclusionary policies and related issues. In that way, the fusion between Dr. Stimmel's vision and social reality could be realized.
Janice S. Lieberman, Ph.D.