Although scores of anecdotes are told about the seriously impaired training analyst, supervisor, or classroom teacher, no well-defined approach to the problem is readily available. Tragically, it is not infrequent for everyone involved to exhibit the “blindness of the seeing eye” when faced with the problem.
Denial of an impairment to the analyzing function in the training analyst may be assisted by the belief that the analyst is simply adhering to good technique, which is to reveal nothing and explore the patient's fantasies. This posture, though acceptable in an analyst who is ill but otherwise functioning optimally, becomes unacceptable when the analyst, precisely because of the illness, cannot properly carry out the work of analysis.
In defining the term impaired analyst, it is best to cast a broad net, one that includes impairment in the analyzing function caused by (a) aging accompanied by a decline in the capacity to analyze, (b) substance abuse, (c) medical illness without insight into its effect on one's analyzing function, and (d) psychiatric illness including some types of character pathology manifested by grandiosity or financial exploitation. An allegation raised recently in the Freud-bashing literature can stand as an example of grandiosity and financial exploitation. Freud allegedly advised Frink, an analyst and former patient, to divorce his wife and marry a wealthy patient with whom he was having an affair. He was then to contribute to the psychoanalytic cause. The result was disastrous. Freud is a good example because he is so well known and because his life and work are so richly ambiguous that he lends himself to widely varying opinions and judgments. He was, of course, also afflicted with a fatal illness for the last third of his career, during which time the episode was alleged to occur.
Once impairment has been defined, a variety of questions arise. Should a typology or nosology of impairment be developed? Who is to receive reports of alleged abuse or inadequacy, and how should such complaints be prepared, transmitted, evaluated, and acted upon? How should assistance be provided the analyst once a determination has been made that indeed there is a need? How are candidates affected by the teaching analyst — as students, supervisees, or analysands — to be assisted? Should concern be extended to the patients of candidates in training analysis or supervision with the impaired analyst? What type of monitoring is appropriate once remediation has begun? Who should do it? What preventive measures can be taken?
The literature in this area remains sparse. Many of those with the most experience in these matters have never published their findings. Freud himself wrote nothing on the topic, though there is reason to believe that the papers on technique were precipitated by difficulties experienced by his students that might now be described as impairments. His late recommendation that analysts return to personal analysis every five years may well have been made with prevention in mind.
How prevalent is the problem? Richard Lasky reports that at a discussion group where his paper on the impaired training analyst had been precirculated, a full half of all participants wanted to discuss their own experiences with an impaired or dying training analyst. Others wanted to tell of their experiences with an impaired supervisor. The ensuing discussion suggested that many training committee members fear that broaching the subject with an impaired analyst might only exacerbate the problem.
COPE, the Board's Committee on Psychoanalytic Education, has established a study group to examine the issue of impaired faculty. In December 1994 its first meeting was held. The goal is to study the range of such problems and the ways various institutes have responded. Although the study group cannot function in a consultative or administrative capacity, it has begun to collect information, confidentially, from each member institute. Of particular interest are approaches and procedures that have proved successful in dealing with the resistance to act in clear cases of impairment. Information in this area will be collated and made available to institutes for their consideration. Members of the study group are William Bernstein, Paul Dewald, Ralph Engle, Newell Fischer, Rhoda Frenkel, Eugene Goldberg, Morris Peltz, Paul Roberts, Lorraine Siggins, Robert Tyson, and Jerome Winer (chair). They represent a wide range of geographic locations, both large institutes and small, and both relatively new ones and some of the oldest. Members of The American who have relevant data should feel free to contact anyone in the study group.