As readers may know, the Board will soon consider a revision of The American's published standards. A proposed statement has yet to take final form, but some of its features are clear: they will reflect the ongoing discussions of educational policy and practice that make the Board and its committees so exciting and of so much interest to analysts everywhere.
Some things probably won't change, but others will. Wherever possible, the new standards will convey some of the experience and reasoning that have gone into each statement. I believe that it is urgent, in these times of pressure to redefine “minimum” standards of psychoanalytic education, to better define the reasons for the Board's recommendations for the optimal conduct of analytic education. While the word standards may conjure up the idea of rules to be obeyed, in actuality our standards are experientially derived judgments. The Board and its committees are involved in an ongoing examination of educational practices. Each generation must make an effort to understand and evaluate the data of past and present educational experiences. The education currently offered candidates in our institutes includes changes that reflect such ongoing evaluation. It is through the optimal education of candidates that we can ensure the preservation of the opportunities that psychoanalysis alone can offer many patients. In this initial report I will present some of the ideas reflected in these standards as they undergo revision.
The tripartite system, a long-established consensus and the keystone of our educational process, develops the future psychoanalyst through simultaneous immersion in a training analysis, supervised analytic work with a minimum of three patients, and a didactic program in the theory and practice of psychoanalysis. Course work fosters the growth of knowledge and a way of thinking about clinical experience, while the latter provides both a context for understanding the literature on theory and technique and an empirical basis for the psychoanalytic theory of mind. While the training analysis is essentially for the candidate's personal development, from the perspective of the analyst-in-training it can focus on aspects of character and personal conflict that might impede analytic work and make it problematic both for the analyst and for future patients.
Thus, there is an essential interaction between the candidate's supervised analytic work and the personal analysis. It is in supervision that we learn the skills of analytic work and enlighten ourselves as to characterological and conflictual issues that interfere with the optimal analytic attitude of neutrality, tolerance of ambiguity, and openness to inquiry. Supervision can also reveal blind spots. All psychoanalysts are vulnerable to the vicissitudes of life and need to be on the alert for the emergence of problems, either in particular individual analyses or as a more pervasive trend. Our educational experience as candidates should serve as a model for self-inquiry and self-evaluation in regard to confronting and mastering these vulnerabilities.
It is often debated how many hours, and overall how many years, should be devoted to the training analysis, supervision, and course work. Because we recognize that these are essentially educational judgments, optimally arrived at jointly by the candidate and the education committee, our standards are designed to offer qualitative rather than quantitative guidelines. For instance, in regard to supervision they state that “supervision should occur over a sufficient length of time so that the development of a transference neurosis, or significant transference manifestations, can be observed and understood, and the candidate's ability to recognize and interpret the principal genetic factors and principal conflicts can be adequately demonstrated. The supervision should include the period of working through, and the candidate should receive regular supervision until there are indications of an ability to work independently. It is educationally desirable that supervision should be continued through termination in at least one case. If, on the basis of evaluation of clinical competence, an institute graduates a candidate without a case supervised through termination, provision should be made for such an experience after graduation.”
It is apparent that we feel it is more important to present principles and aims to be achieved than numerical requirements, which would be approximate in any case. Such principles rely for their implementation on the thoughtful judgment of experienced and devoted educators. Our standards serve as generalizations around which such judgments can be made and provide a framework and reference points that can guide and ease the efforts of students and teachers.
In regard to the training analysis, our standards recommend that “the analysis of candidates shall be conducted five times a week, four as a minimum, through termination, except when special considerations require temporary interruption or alterations of frequency.” The basis for this recommendation requires clarification. The methodological issues involved in the question of frequency have in recent years been discussed both in the Committee on Institutes and in an ongoing study group of the Committee on Psychoanalytic Education. This Study Group on Psychoanalysis and Psychotherapy, consisting of analysts of diverse theoretical orientations from around the country, was remarkably consensual on the role of the frequency of sessions and continuity in promoting a psychoanalytic process, a process quite different from what occurs in psychotherapy.
One participant in the study group summarized its thinking in the following way: “The frequency of four or more hours per week, combined with the use of the couch and the encouragement of free association, has been found empirically to facilitate the emergence and elaboration of fantasy material in particular and the inner world in general; permits the analyst to sustain longer periods of doubt and questioning, thus helping to avoid premature closure of issues; lessens the risk of confusing the patient's intellectual acceptance of an interpretation with an alteration in defensive structure; allows the fuller development of the transference neurosis; and provides much more opportunity for working through.”
Another participant stated the consensus in this way: “The analytic process is subtle enough that we can at times forget how it is quite distinct from other therapies. A blurring of these distinctions and definitions can occur because we ourselves do not think very differently when we do analysis or briefer therapy. Using the same ideas about the clinical data contributes to a blurring. But there was a strong consensus that the special qualities of the analytic procedure—the use of the couch, the frequency, the more rigorous analytic attitude—contribute to a regressive state, an aliveness of transference and other material, a richness of imagination and an engagement with primary process thinking, etc. that result in a unique state in which changes can occur that are impossible or unlikely in other therapies, even when carried out by the same person. Insight is more likely to occur, for example, when ideas and emotions are joined in the moment and thus carries great conviction. Most of us have seen a
dramatic difference when some patient moves from psychotherapy to psychoanalysis with us.
“So the question of frequency is not trivial and not a matter of economics but of whether an analytic process is likely to get engaged. Most feel that four or five times weekly provides the setting of greatest promise that such a process can occur. This doesn't mean that three times a week may not sometimes succeed. For educational purposes, and for practice generally, the best chance to experience an analytic process in our own training analyses and with our patients will require four times a week as a minimum.”
Our standards are currently being rewritten. It is expected that as much as possible the rationales for our current educational procedures will be included to aid candidates and educators in understanding our rigorous educational programs. We are currently exploring ways in which candidates can participate in the work and discussions of the committee. We hope this will enhance their understanding and provide a means for informing our members of the rationales behind our system of educating future psychoanalysts.
The Board as a whole will discuss and debate these questions as the Ad Hoc Committee on the Revision of Standards, chaired by Bud Heijn and cochaired by Richard Fox and Steve Morgenstern, reports on its progress. The work of other Board committees also relates most meaningfully to issues of standards, and their work too is regularly reported to the Board for full discussion and approval. The Committee on Certification, chaired by Art Rosenbaum, has further developed the concept of psychoanalytic process; the Committee on Child and Adolescent Analysis, chaired by Sam Rubin, undertakes the development and clarification of educational policies in child analysis; the Committee on Institutes, chaired by Steve Morgenstern, through its unique and always evolving site visit processes, has the major responsibility for evaluating the effectiveness of our educational procedures, as well as the problems involved in their implementation; the Committee on Membership, chaired by Richard Fox, surveys graduates' actual educational experiences with the tripartite system; the Committee on New Training Facilities, chaired by Dave Carlson, formulates guidelines for new institute development and works with new facilities in developing means for their implementation; the former Committee on Nonmedical Clinical Training (now the Committee on Preparedness and Progression), chaired by Phyllis Tyson, has worked to clarify the prerequisites for psychoanalytic training, as has the Committee on Research and Special Training, chaired by Deanna Holtzman; and the Committee on Psychoanalytic Education, chaired by Sandy Abend, has ongoing study groups on such important aspects of analytic education as supervision, curriculum, the problems of various groups of candidates, etc. All these committees, which report collectively to the Coordinating Committee of the Board, will have recommendations and input into the work of the Ad Hoc Committee on Revision of Standards. All these committees have broad representation from our institutes, including in some instances the participation of candidates, and it is through their presentations and ongoing deliberations and discussions with the Fellows of the Board, who are appointed by all our institutes, that we can arrive at a consensus regarding our educational procedures.