In the spring of 1991, Ralph Engle, liaison from The American to the Minnesota Branch Training Facility, suggested to Mark Leffert, a local Minneapolis psychoanalyst and representative to The American's Committee on New Training Facilities, that psychoanalytic psychotherapy training should be available in the Twin Cities. The idea of psychotherapy training offered by local analysts was also being independently considered by Edie London, recent past president of the Psychoanalytic Foundation of Minnesota. This made for a ready partnership between the study group and the foundation. Within a year, a Training Committee had been established: Mark Leffert as director, Mike Moore, Nancy Kobrin, David Stagner, Alan Serposs, and Edie London. (At present, the committee also includes Steven Clarke, Gerald Ronning, Pat Torrey, and Virginia McDermott.)
A training program had never before succeeded in a psychoanalytic community as small as that in Minnesota. In order to evaluate community interest in such a program, the Training Committee sent a questionnaire to more than 100 social workers, psychologists, and psychiatrists who were members of the foundation or had attended educational events sponsored by the study group and the foundation. The response indicated a considerable degree of interest, as did discussion with many of the respondents. The Training Committee proposed to the study group and the foundation that planning proceed in earnest. Most members of the study group who were not already members of the Training Committee offered their services as teachers and supervisors.
The next step was curriculum development. The Training Committee investigated other programs. In particular, Diana Nugent, Administrative Director of the Boston Psychoanalytic Society and Institute, gathered curriculum details of the Boston Advanced Psychotherapy Training Program. The committee decided to offer a three-year program. Two one-and-a-half-hour courses would be offered weekly in each of three 12-week trimesters, for a total of 18 courses over the three-year period. Almost all classes were to be taught by graduate analysts, with occasional lectures offered by senior analytic candidates.
The current first-year courses are Basic Concepts of Psychoanalysis, Interview and Assessment, Child Development I, Transference, Beginning Therapy (Continuous Case), and Child Development II. The second-year courses are Adolescent Development, Psychoanalytic Psychopathology Including Neurosis and Depression, Middle Phase (Continuous Case), Object Relations Theory, Dreams, and Countertransference. The third-year courses are Clinical Writing, Issues of Gender and Sexual Identity, Self Psychology, Terminating Psychotherapy (Continuous Case), Adult Development, and Brief Psychotherapy (including several sessions on ethics). The classes meet at locations decided upon by students and instructors.
Supervisors — either graduate analysts or senior candidates — are assigned by the Training Committee. The program requires 20 hours of supervision yearly, although many students request additional supervision. The additional supervision has been graciously provided by individual supervisors at the fee set by the program. Each student is asked to obtain supervision on two twice-weekly adult or adolescent psychotherapy cases from his or her own practice for at least one year. The program strongly encourages students to see at least one case through termination.
Each student is assigned an advisor with whom to discuss supervision and class experience as well as individual needs and concerns. While students have used their advisors occasionally, the students frequently offer feedback to whomever they are most comfortable with — often a supervisor. Occasionally, a meeting is arranged between the students and members of the Training Committee. The great majority of the views offered by students have been constructive.
At the end of each course, instructors evaluate each student's participation, attendance, and apparent understanding of the discussed material. At least twice yearly, supervisors write a summary of their supervisees' clinical work. In most cases the remarks of the students, instructors, and supervisors has provided the Training Committee with enough timely information to address difficulties at a relatively early stage of development.
Applicants must have a graduate degree in a mental health discipline, a license to practice independently, and malpractice insurance. They must complete an application, forward academic transcripts, and submit a written report of a psychotherapy case. In several instances applicants were not familiar with case writing, and a member of the Training Committee advised and assisted the applicant with this process. Two letters of reference attesting to the ethical and intellectual qualities of the applicant are also required.
Once the necessary materials are submitted, each applicant meets with a member of the Training Committee. The interviewer then presents the applicant to the committee for discussion and ranking for acceptance. A maximum of 10 applicants are accepted, limited by the number of available supervisors.
There have been several applicants who, while genuinely interested in the program, did not fall into one of the categories outlined above. Committee members met with these applicants individually and sought ways to support their interest. One former applicant, an experienced chaplain at a local hospital, has been meeting with an analyst twice monthly for the past four years to discuss her work from a psychoanalytic perspective.
The total fee for the three-year program is $9,450. This includes $550 paid each trimester to the program directly and $75 for each hour of supervision, paid to individual supervisors. Approximately half of the courses require rather extensive reading. Each instructor is paid $150 for teaching each 90-minute class, a total of $1,800 for each course. Considering these fees plus accounting and legal fees, a minimum of eight students is required for the program to be financially viable. Class size is limited to 10 to allow a close group process to develop.
Perhaps the most difficult and time-consuming aspect of establishing the training program has centered on organizational and legal concerns. The program was established as a 501(c)(3) educational organization. However, due to a series of missteps, the instructors and supervisors were initially found to be employees rather than independent contractors, which greatly complicated administrative requirements for the first three-year program. The most significant misstep was in failing to understand the meaning and implication of the criteria used by the IRS. After the committee obtained extensive legal advice, with much effort and additional confusion, the problem was corrected. The program no longer requires the services of a payroll company to assist it with its very simple payments, which do not involve any tax withholding. This experience has shown that it is of utmost importance to receive legal advice from someone experienced in this area before completing the IRS questionnaire.
David L. Stagner, M.D., an analyst in St. Paul, Minn., is a graduate of the Boston Psychoanalytic Society and Institute. He is a member of The American's Committee on Societies.
Our first three-year class was completed in the spring of 1996. All 10 participants graduated, and many of them wished to continue their affiliation with the local study group. Likewise, the study group members who were involved in the Training Program wanted to continue their affiliation with the graduates. The study group voted to establish a “Psychotherapy Affiliate” category of membership for graduate and ongoing trainees of the Training Program. Eight out of 10 of the initial class opted for study group membership. These members are currently serving on committees and participating in other ways.
After a year break, the second three-year class of 10 students began in the fall of 1997. One applicant lives some six hours away from the Twin Cities, and it was decided to try teleconferencing for those sessions where attendance would be made extremely difficult during winter weather. The committee hopes that this approach will allow the established group process to continue and will enhance future attendance and outreach.