Although I have been asked to write about psychoanalytic education and training from the perspective of psychologists, I believe that the fates of all who approach psychoanalysis, from whatever discipline, are ultimately linked. The challenges facing psychologists are confronted, in some form or other, by all who value psychoanalysis.
As we think about psychoanalytic education and training for psychologists, it is useful to conceptualize a spectrum of educational offerings, from informal discussion groups to full-fledged training programs both within and without the institutes of The American. The Division of Psychoanalysis (39) of the American Psychological Association (APA) has approximately 4,200 members, seven sections, and twenty-eight local chapters. Division 39 sponsors two major scientific conferences each year, a spring meeting that may draw as many as 1,500 registrants, and a smaller meeting offered in conjunction with the APA summer conference.
In addition to national meetings, local chapters offer throughout the academic year a range of lectures, seminars, and workshops on various psychoanalytic topics. Local chapters include not only psychologists but psychiatrists, social workers, and others with an interest in psychoanalytic thought. Together they create a climate of opinion that nurtures psychoanalysis at a time when political and economic institutions are increasingly hostile to it.
Although most undergraduate curricula do not include courses on psychoanalysis, some members of local chapters teach part-time at the undergraduate level. Indirectly, they help sustain psychoanalysis by introducing analytic ideas in a wide variety of courses.
In several localities over the past decade—e.g., in Boston, San Francisco, Denver, and, most recently, Toronto—psychologists active in their chapters have provided leadership in the formation of independent psychoanalytic training programs of high quality. These relatively new institutes have complex relationships, both competitive and cooperative, with the older institutes of The American. These relationships range from rivalry for candidates to joint educational offerings and the sharing of faculty, analysts, and supervisors.
Unfortunately, the vitality of Division 39 has not prevented the decline of psychoanalysis in clinical psychology programs in graduate schools throughout the country. In order to survive, these programs have responded to the enormous changes in the marketplace that have been wrought by managed care. Fewer programs offer a psychoanalytic perspective, while many more turn toward cognitive-behavioral and short-term approaches. As a result, graduate students with an interest in depth psychology postpone their psychoanalytic studies altogether or seek teaching, mentoring, and support outside the official channels of their program. Division 39 is looking for ways to provide some of these educational opportunities. Not infrequently, however, graduate students believe they must conceal their interest in psychoanalytic thought from those in charge of their formal academic training.
Even in the few graduate programs that provide more extensive course work in psychoanalytic/psychodynamic approaches, students experience great strain because of the demands of their clinical placements. As one graduate student commented, “There was often a dichotomy between the long-term analytic models of therapy we were being taught in classes and the short-term crisis intervention work we were doing at our practicum and internships. This tension was constant, and other students often wanted more emphasis on short-term work or cognitive-behavioral approaches.” Through her industry and initiative, this student pursued a postgraduate fellowship in a child and adolescent treatment center that still valued psychoanalysis.
A small number of highly motivated individuals will make it through the obstacle course to pursue their psychoanalytic interests at the graduate and postgraduate levels. One senior psychologist analyst commented, “Most of my teaching is at psychoanalytic institutes, the local chapter of Division 39, private consultation and study groups, and at a clinical training program to which psychology graduate students come for placement, along with psychiatric residents, social work interns, developmental psychologists on sabbatical, and the like. I certainly feel that there is interest in psychoanalysis, with a number of graduate students being avidly, if not passionately involved in it.”
Sharing the enthusiasm of this senior analyst, a younger psychologist who recently completed a postdoctoral internship in a treatment center with an analytic orientation summed up her experience: “Overall, there is no question in my mind that psychoanalytic training provided me an understanding of human behavior that is more comprehensive than any other theory I have been exposed to.” She reflected that she would need to immerse herself in the complexity and subtlety of psychoanalytic ideas in order to acquire sufficient mastery and integration.
Unfortunately, many other bright and talented individuals will be deterred from pursuing analytic education and training because of the daunting realities of the marketplace. Fewer graduates of clinical programs will be able to practice psychodynamically. In order to make a living, many will seek employment in HMOs and other managed care settings. There it will be difficult, if not impossible, to sustain an interest in depth-psychological approaches.
Individually and organizationally, we need to do all we can to develop and maintain psychoanalytic education along the entire spectrum from the undergraduate to the postgraduate level, including full-scale training. However, unless those who are trained can practice psychoanalytically, our efforts will prove futile. To maximize profits, managed care entities are skillfully exploiting realistic concerns over the economics of health care to squeeze out and eventually eliminate intensive long-term treatments, not only from integrated systems of providers but from the private sector as well. Private practice remains the one bastion of psychoanalytic treatment, but even it is under siege.
Psychoanalytic organizations that share similar values and standards need to overcome their parochial differences, perhaps through the Psychoanalytic Consortium, and formulate an integrated strategy to preserve the private practice of psychoanalysis. Such a strategy would include large-scale outcome research to document the effectiveness of psychodynamic treatment and a coordinated campaign to educate legislators and the public regarding these findings. In response to the challenge and the threat posed by health care reform, we began to move hesitantly in those directions. Following the demise of the Clinton Health Security Act, we need to redouble our efforts. If we fail to mobilize ourselves, individually and collectively, analytic education and training will be marginalized and fewer psychoanalytic practitioners will be available to serve a dwindling number of patients.
James W. Barron, Ph.D., is past president of Division 39 and is currently a candidate for APA president.