Candidates from three institutes in the Los Angeles area were recently asked to respond to an informal telephone survey. Two of the institutes—the Los Angeles Psychoanalytic Society and Institute (LAPSI) and the Southern California Psychoanalytic Institute (SCPI)—are affiliated with The American, while the third, the Institute for Contemporary Psychoanalysis (ICP) is independent. Four other area institutes—the Psychoanalytic Center of California, the Los Angeles Institute and Society for Psychoanalytic Studies, the California Graduate Institute, and the Jungian Institute—were not represented. The views described are those of candidates at all levels of training, as well as those of some recent graduates.
Of 25 candidates contacted, 23 responded to the request for a telephone interview; twelve are from LAPSI, five each are from ICP and SCPI, and one has dual membership at the latter two. Each was asked to provide a description of overall satisfaction or dissatisfaction. This request was followed by questions pertaining to course content, perceived intellectual atmosphere, knowledge and interest in social and organizational/political matters, morale, and feelings concerning their future as psychoanalysts. Finally, recommendations for improving the training experience were elicited. Interview time ranged from 25 to 60 minutes. What follows is an admittedly impressionistic attempt to frame the results of this informal effort.
Regarding the components of the tripartite educational model (training analysis, seminars, and supervision), some candidates feel that the time and effort they invest in seminars is not commensurate with the benefits. Although virtually all of the respondents express their enjoyment of the intellectual content of courses, some say they cannot evaluate the extent to which seminars enhance their development as clinicians or theoreticians. They find this ambiguous state of affairs uncomfortable and frustrating. Others feel that their clinical skills have indeed improved as an outgrowth of their experience in seminars. By the completion of training, some feel equipped to critically evaluate and challenge the body of literature. Those who are pleased with their curriculum state that they are acquiring a diverse theoretical base from teachers who are respectful of multiple points of view and who draw on both historical and contemporary sources. However, a number feel that the widening scope of analysis presents problems for the curriculum, as depth is often sacrificed for breadth. Four of the five candidates at ICP are delighted with their curriculum, which they describe as having a contemporary focus supported by contextual historical readings. One feels very strongly that the curriculum is seriously deficient in Freud. Those at LAPSI and SCPI who are critical of ICP consider it impossible to achieve a comprehensive and richly textured understanding of psychoanalysis without a thorough knowledge of Freud and his contemporaries.
At all three institutes, class discussions appear to be engaging, broadening, and at times scholarly. Free expression and the exploration of ideas is encouraged. There is a balance between rigorous commitment to critical inquiry and creative playfulness. Some at LAPSI think too great an emphasis is placed on theory. They would prefer a more clinically and technically oriented “trade school” sort of curriculum that would focus on the panoply of psychopathology and clinical management.
Many experience an enriching benefit from having classmates with varied backgrounds. However, some find that tension exists in classes composed of people with different professional backgrounds and varying degrees of clinical experience. Different levels of clinical sophistication stimulate envy of those more advanced and devaluation of those deemed less so.
In the realm of biases, there is minimal perception of dogma or indoctrination. A few experience the occasional teacher as deifying a single brilliant theory or person. Some at SCPI think the curriculum reflects the hegemony of Freud. At both LAPSI and SCPI a few nonmedical trainees perceive subtle prejudices in the form of covert messages from the faculty that gifted non-M.D.s are a rarity. These students feel a pressure to redeem themselves. Some express envy of the physician, whose acceptance in the field seems unquestioned. By contrast, a number of candidates, including some at ICP, feel that some individuals at that institute evince a subtle antipsychiatric attitude.
All of the respondents doing supervised analysis are excited about the clinical work. One concern is that candidates will be unable to learn ideal technique if it is not demonstrated. Consequently, they would like conferences in which senior analysts present their own cases. In that vein, Arlow and Brenner have wondered how analysts will agree on a standard method of observation if senior analysts are unwilling to demonstrate how they observe, think about, and interact with their patients. In any event, greater emphasis on technique and process is needed, and case conferences should focus less on content, regardless of who presents the material.
Group processes within seminars, and in institute life generally, are manifold and complex. The majority feel that the institutes are seriously invested in candidates' development as analysts—that their ideas are respectfully considered in the mutual endeavor of continuous revision and refinement that constitutes training. They feel a certain comradeship, however awkward at times, with faculty. For others however, the atmosphere is paranoiagenic. The reasons such candidates give are congruent with those described by Kernberg and Arlow. To begin with, some teachers are almost silent in class, thereby contributing to the transference orgies that are already problematic in that regressive atmosphere. Splitting, displacements, and projections from the training analysis are amplified. Similarly, many feel excluded from institute secrets and squabbles. It could well be argued that sometimes ignored adults are in fact ignored adults, and not just children left out of the parental bedroom. Although often not made privy to serious conflicts in the organization, most candidates seem eventually to learn of them. To obviate the problem, faculty meetings might well be opened to candidates, who are capable of deciding whether or not to go, and of taking responsibility for analyzing the impact that attending meetings might have on their development. In addition, idiosyncratic and inconsistent approaches to candidates, combined with a lack of professional administrative efficiency, often exacerbates a concern about not being treated equally and fairly. For instance, LAPSI lacks any formal policy regarding feedback on course evaluations, whereas at ICP and SCPI all candidates receive written evaluations at the completion of each course.
For quite a few it would seem, progression in training is experienced as an overextended exercise in hazing. Initiation rites have been endured in college, medical school, residencies, and graduate school. As Arlow has noted, this induction is perpetuated intergenerationally via identification with the aggressor. ICP, in contrast to the other institutes, is experienced as egalitarian. Candidates are voting members on all committees, including the student progression committee. Further, all graduates who continue to function in the institute automatically become training analysts five years after graduation. It appears to all that ICP functions for now as a classless society.
On this note, Arlow observes that there exist two classes of analyst, training and non-training, and that the latter's discontent may foster a reticence about introducing ideas within their institute. Some candidates feel they belong to yet a
third class, and although generally not inhibited in seminars they rarely introduce ideas outside the classroom. An in-group/out-group perception is thereby instilled and perpetuated via the idealization of training analysts and the devaluation of non-training analysts. Some candidates may well have the experience of living on the margin. As training progresses, the awareness of impending membership furthers a process of identification and alienation whereby one conceives of characteristics that pertain to those in the group or subgroup one wishes to join. Non–training analysts are easily subgrouped into those who are disaffected or disaffiliated, and those striving (often with Sisyphean results) to join the elite coterie of training analysts; most candidates have difficulty identifying with either. Nearly all of those interviewed aspire to achieving training analyst status automatically, with no postgraduate initiation save perhaps a requisite waiting period, as at ICP. All except two of the candidates expressed a serious lack of interest in becoming certified unless the process is changed.
Part of the problem lies perhaps in the fact that people enter an organization with two different and sometimes mutually exclusive sets of needs. On the one hand they want a sense of solidarity, security, and shared purpose, while on the other they have a need for unique prominence or recognition. Social psychologists and management theorists have recognized this duality for some time. In Contingency, Irony, and Solidarity, the philosopher Richard Rorty discusses the issue in terms of language. Each person, he argues, has a unique and idiosyncratic language, and yet shares a language of solidarity with others; functional failure occurs when people try to collapse this dualism, an impossible endeavor because the individual needs to live in both domains. The dichotomy is ever present.
This conflictful need to be part of the club while standing outside it is reflected in the designation of students as “clinical associates” instead of “candidates.” The word candidate reflects future goals, ideals, or status; the term clinical associate favors the domain of solidarity, parity, and affiliation, while downplaying issues of hierarchy, election, status, and unique individual strivings.
Most current training analysts were educated at a time when there was a coherent ideological center and a single group of people with whom to identify. There was then far greater community interest in psychoanalysis. Analysts were respected in departments of psychiatry and were able to earn a living as clinicians doing analysis. Being part of the profession of psychoanalysis then could meet an individual's needs for recognition and for the development of an idiosyncratically contingent language, primarily through the vehicle of the training analysis.
As the individual languages of now senior analysts developed, solidarity eroded, as the languages also diverged. Most students today appear to feel a shared interest in learning about psychoanalysis, but not all feel solidarity and collegiality. Most of those interviewed do not rely on the institute to fulfill their social needs, as did their mentors before them. Some fear that their opportunity to practice analysis will be limited, as psychoanalysis is today misrepresented or devalued both in the community and among third-party payers. The lack of respect for analysis among departments of psychiatry is painful to those who need role models to help them integrate a professional identity as medical analysts.
Those who feel uninterested and unaffected as regards institutional politics say they just can't be bothered. Taking precedence in their lives are busy practices, family, and training analyses. They are focused on learning and on obtaining supervision. Those who are interested cite myriad reasons: tension and turbulence abounds as a result of the widening scope of psychoanalysis and its shift away from both orthodoxy and medicalization; political, ideological, and organizational conflicts among institute faculties often reflect those between local institutes and The American. The effects ripple into even the earliest seminar years. One result of the recent upheaval and splintering that led to ICP's formation was that four SCPI candidates transferred to the new institute.
When ICP opened in 1991, it was a confusing and deflating time for many candidates at LAPSI and SCPI. It was difficult for them to maintain their idealizations of their mentors and their institutes. They worried about being abandoned by their teachers and supervisors, and about being excluded from something perceived as potentially paradisiacal. Here was yet another opportunity for transference splits to occur. Many who begin analysis and training are hoping finally to belong to a happy family. Instead, in this instance a divorce occurred. Disillusionment, an intrinsic part of psychoanalysis, seems to have been supplied to these trainees in extra measure, not so much because the institutes split, but because no one has really talked about it. SCPI candidates feel a tremendous loss of the analysts who left, and many at both SCPI and LAPSI feel envious of the energy invested in change, advancement, and experimentation that has been siphoned off to ICP. They are disheartened by psychoanalysts' inability to be a more carefree and integrated body. Here is yet another disappointed Utopian dream that needs to be worked through.
Another important factor contributing to low morale is the availability of fewer patients, a condition perhaps caused by the huge number of mental health professionals competing for the same pool of patients, and the economic crisis which has led to the advent of managed care precertification requirements and diminished insurance coverage. As a result, some believe that clinical analysis will continue for the rich and/or will become narrowly defined by the public as the treatment of choice only for patients with severe character disorders. Nonetheless, though most candidates hope to practice some analysis, maintaining enthusiasm has been especially difficult for those who are the sole support of their families. The two candidates who are optimistic that they will have analytic practices comprised of high functioning neurotic patients happen to be secondary wage earners.
Hope for the future lies in actively recruiting and respecting trainees, and in eliminating authoritarianism. Engaging candidates in a discussion about the future of their institutes, and teaching them about psychoanalytic education and research, is crucial. Helping candidates integrate their previous training with analytic training is also important, and programs must be developed to integrate biological advances. The profession cannot proceed as if psychoanalysis alone is a viable income-earning option for all. An ecumenical interest should be shown in other interventions and fields, and a serious attempt should be made to determine their impact on psychoanalysis. Finally, psychoanalytic organizations must be democratized if candidates are to feel proud and enthusiastic about being members.