The word “hunger” comes up repeatedly as one reads applications to The American's Fellowship Program, talks to applicants and Fellows, and speaks with mentors. Early career trainees and professionals in the mental health fields, the majority of whom were attracted to their fields of study by a deep and abiding curiosity about what makes people the way they are, a fascination with the stories of individuals, are frequently frustrated by the soullessness of their training experiences. The psychiatrists protest the reductionism of descriptive psychiatry and symptom checklists. The young psychologists are faced with the insistence that any treatment not empirically validated is unsound. The social workers are told that psychodynamic perspectives in understanding patients are irrelevant. Training programs in all the fields have lost the psychoanalytic and psychodynamic teachers and supervisors who dominated instruction even a decade ago. Young clinicians are often trained as if the constraints on treatment imposed by managed care are clinically, not economically based.
In this context, where the identities and commitments of mental health professionals are being formed, the Fellowship Program of The American finds its vital niche. The program, now in its eighth year, has followed a natural course of evolution from its early days of nurturing psychiatric residents, and now serves all three of the major mental health professions. Applications from clinical social workers were welcomed for the 1998–99 Fellowship class. Seventeen applications from clinical social workers were received (as well as nineteen from psychologists and ninety-two from psychiatrists), and two of the fifteen winners are outstanding professionals in clinical social work [see the winners' biographies on pages 9–10].
Clinical social work today occupies a vast segment of the mental health training and service delivery systems. Decades ago, psychoanalytic theory played a large role in informing the education of young social workers and in social workers' clinical practice. Today, psychoanalytically dedicated educators and leaders in social work struggle to keep the influence of analysis alive in schools and clinics.
Leaders in social work were very excited when The American opened the Fellowship Program to their future teachers and leaders; it assists them in their effort to reintroduce psychoanalytic thinking into the field. Jean Sanville, co-author with Joyce Edwards of the recently published Fostering Healing and Growth: A Psychoanalytic Social Work Perspective, said, “Schools of social work that used to teach from a psychoanalytic perspective mostly don't anymore. Throughout the country, it's been dropped.” Sanville and Edwards, who were among the leaders who helped the committee publicize the Fellowship to the social work community last January, are part of a nationwide effort to get psychoanalysis back in the door of social work training.
“There is a hunger. People have almost no psychoanalytic notions. They are vaguely interested in this thing called psychoanalysis, but they really don't know what it is. The people that do get into the Fellowship program will influence others,” said Sanville. Margaret Frank, past president of the National Membership Committee on Psychoanalysis in Clinical Social Work (NMCOP), applauded The American's expansion of the Fellowship: “Opening the Fellowship to social work reflects the spirit of the Psychoanalytic Consortium.” Frank echoed Sanville's sentiment that the Fellowship will assist the leaders in social work who are actively engaged in trying to increase the study of psychoanalytic theory in social work training programs.
The Fellowship is structured to take advantage of what my colleague Steve Post, referring to the psychoanalytic foundations' work, has called “the ripple effect.” The American makes a substantial investment of resources in a relatively small number of people; this year we have fifteen Fellows, chosen from 128 applicants. But this is a very special group of people. They have already demonstrated leadership capacity in their professional work, have substantial research experience, often have published widely, and are active members of a variety of societies and committees. They initiate new community projects. They are future educators and leaders in mental health, and they will determine curricula, philosophy, and policy in the years to come. Our aim is to expose them to The American and to psychoanalytic thinking at an early phase of their professional development.
Demographically, the 1998–99 applicants and Fellows are similar to those in recent years. Applications were received from twenty-four states. The Fellowship Committee is eager to serve psychoanalysis throughout this country, and to that end we will continue to work with local societies to recruit applicants actively in areas that have been underrepresented. Among applicants were thirty-two international medical graduates from twenty countries. The applicant group is amazingly diverse. Forty-four people are foreign-born; they come from thirty-one countries around the world, bringing an unparalleled richness of cultural experience to the program. The applicants' as well as the winners' pool is quite well balanced between men and women. The average applicant's age is thirty-six.
Prudence Leib, M.D., is a member of the faculty of the Chicago Institute for Psychoanalysis and chair of the Fellowship Committee of the American Psychoanalytic Association.
No one loses in the Fellowship Program. All applicants, not just winners, are assigned a mentor with whom they meet at least monthly. All receive a subscription to TAP. One winner mentioned in her application that she was inspired by TAP's series of articles on psychoanalytic work with disadvantaged populations in her own work in a poor Latino community. Mentors meet with applicants to discuss cases, review articles, help with research. A very important function of mentors is to invite mentees to local psychoanalytic meetings. It can be very daunting to walk in cold to a psychoanalytic society meeting, even if it is open to outside professionals; being welcomed and escorted in can make a definitive difference in a young trainee's experience of the psychoanalytic community.
In addition, winners of the Fellowship have all their expenses paid to two annual meetings of The American, receive numerous gifts of books from psychoanalytic presses, receive a subscription to JAPA, have the opportunity to meet with other Fellows and analysts from all over the country, and are included in the activities of the Fellows' Alumni Association. Winners with specialty interests such as outcome research, neurosciences, child treatment, or cross-cultural issues are matched with analysts who share these interests to serve as secondary mentors.
The Fellowship Program works on both a local and a national level. The Society Initiatives Subcommittee of the Fellowship Committee, under the leadership of Margaret Hamilton and Helen Desmond, works with local societies to increase the number of applicants and establish local courses for Fellows and applicants.
The effect of the Fellowship program in a given community can be striking. In North Carolina, for example, this year for the first time there were applicants from the eastern part of the state, an area far from the psychoanalytic center at Durham and Chapel Hill. Thanks to the availability of the Fellowship program and the efforts of Douglas Finestone, a recent graduate of the University of North Carolina-Duke University Psychoanalytic Education Program who joined the faculty of East Carolina University School of Medicine in Greenville, psychoanalytic thinking is permeating the psychiatric residency at East Carolina. Nancy Livingston, mentor to one of the three East Carolina applicants, noted “how hungry people can be for information about psychoanalytic concepts, for looking at psychological and unconscious meanings.” Her mentee has been enthralled by the opportunity to look at psychosomatic concepts from an entirely new point of view.
Livingston mentioned how exciting it is “to see the impact of psychoanalysis outside a major analytic center. … We forget how powerful what we have to offer is, and how eager people are to affiliate with us.” The Fellowship program, she says, gives residents and others a way they “can get connected with an organization where this is the focus. That's why they're doing this. They want to be affiliated with something different from what they had before.” Livingston also has seen the impact a winning Fellow can have on a local community. She reports that two Fellows from Duke have been very vocal about the program over the past few years and have increased the number of applicants from the area.
A number of local communities have independently established local fellowships more or less modeled on The American's national program. These local fellowships are operating in Philadelphia, Chicago, and Seattle and at the New York Psychoanalytic Institute and are extremely popular. Because travel is unnecessary and mailing costs minimal, the programs require little in the way of financial outlay for local institutes and societies, but they reap tremendous rewards in terms of outreach to the community, good public relations, candidate recruitment, etc. The general model is to offer a mentor, a course, and a welcome into local psychoanalytic meetings. The Fellowship Committee will be gathering information from around the country on these spontaneous efforts and organizing a workshop on the subject at an upcoming meeting of The American so that other communities can consider the value of establishing local fellowships.
Another current focus of the Fellowship Committee is to coordinate its efforts with other committees of The American. We have much in common with the work of the committees on psychotherapy associates and student associates. We are working with the Committee on Racial and Ethnic Diversity to co-sponsor a workshop on conflicts faced by early career professionals with Asian backgrounds as they strive to integrate an interest in psychoanalysis with Asian cultural values, which can conflict with psychoanalytic values. We have been approached by the Committee on Research and Special Training to see if the Fellowship can be expanded to include academics and others outside the mental health fields. We are working with Canadian analysts to coordinate the Fellowship with their outreach efforts.
The Fellowship Program is a point of contact with or entrance to The American for many disparate groups and individuals. We are working with the Committee on Societies to collect information on local programs and contact people so that the many callers we get can be directed to local society and institute activities — at the same time as they are welcomed into the Fellowship Program, if eligible.
The extraordinary impact of the Fellowship Program is in large part due to the tremendous effort and creative energy of Elise Snyder, who just finished a seven-year term as chair, and the hardworking committee she led over the years. Nearly 150 members of The American volunteer their time each year to serve as mentors for our applicants. Twenty-two analysts read applications on cold February nights to assist the fifteen dedicated committee members in scoring and ranking applicants. I wish I could thank everyone by name.
Applications are now being accepted for the 1999–2000 fellowship. Brochures and applications are available from the central office (call 212-752-0450, ext. 12). Please encourage your young colleagues, supervisees, and students to apply to the program. Bruce Levin, a member of the Fellowship Committee, will be gathering information from around the country on these spontaneous efforts and organizing a workshop on the subject at the May meeting of The American so that other communities can consider the value of establishing local fellowships.