Our institutes are experiencing new demands as the social, professional, and health-care environment changes. The last major study of psychoanalytic education dealt with many controversies, but it took place in 1974, at a time of more modulated change and more theoretical tranquility. Although it had the foresight to anticipate health-care changes, it did not foresee the anti-psychological pressure of the HMOs and behavioral health carve-outs. The many issues that we encountered in the 1980s and '90s were emerging even then and beginning to demand solutions.
Project 2000 is a committee of the Board on Professional Standards that was formed to identify key issues facing psychoanalytic education as our profession continues to evolve. For example, our candidate population is different from what it was 20 years ago. The number of psychoanalytic treatment models an educated psychoanalyst should know about has expanded. Areas once considered unrelated to psychoanalysis (e.g., medication, cognitive sciences) are explored and debated as educational issues, after years of mutual ignorance. Opportunities to use psychoanalytic expertise outside the analyst's office are being explored (prevention of violence, organizational consulting, sports psychology, etc.)
We have begun by looking at how candidates are educated. From our own experience, and after consultation with educators and candidates, we have framed some key questions for our institutes. Their answers should provide a basis for a discussion of the future of psychoanalytic education. Our primary focus will be the skills, attitudes, and knowledge we communicate to psychoanalytic candidates. (We will have to leave aside many other issues germane to psychoanalytic education, since the scope of even our limited focus is already daunting.) A most important new feature of this committee's work is its inclusion of perspectives from candidates and recent graduates.
Candidates today come from the three primary mental-health areas and thus reflect a greater diversity of educational and clinical experience. There are higher percentages of women, of candidates with family responsibilities, and of older candidates with considerable maturity, responsibility, and life experience. All are seeking training in a profession that does not enjoy the community support it used to. They anticipate a wider range of professional activities after graduation. The need for a rigorous and well-planned education to justify the sacrifice of family time and income has a keener edge than formerly. To some extent, our survival as an organization of the brightest and most talented mental health professionals depends on our capacity to offer a high-quality education that also recognizes the realities of today's and tomorrow's professional life.
Most importantly, Project 2000's critical review stands to enhance the professional prestige of The American and its component institutes among educators and potential candidates, and it is likely to enhance the morale of its graduates.
These are the questions we asked our institutes.
How has the change in the backgrounds of your candidates affected the training program?
Many believe clinical immersion is central to [the optimal functioning of the tripartite system] and to the formation of a psychoanalytic identity. What are the implications of this for what seems like the fact that in many institutes it is difficult for candidates to find suitable training cases in a timely manner?
How much is the teaching of clinical technique integrated with teaching the theories of the mind?
How much do you emphasize approaching the psychoanalytic literature from the perspective of critical thinking versus absorption of material?
Do you emphasize the research potential of the psychoanalytic method as a way of advancing clinical theories?
Can you tell us about any efforts that you may have undertaken to learn more about the optimal atmosphere for learning in supervision and the classroom? For example: relationship between candidates and faculty or approaches to evaluation or styles of teaching and supervising, etc.
Now that the theory of psychoanalytic technique has become more pluralistic, how are the current controversies taught?
What is the role of Freud's clinical thinking, and the controversies that evolved from it, in the curriculum?
Do candidates have the opportunity to hear experienced analysts present throughout the curriculum?
What is the role you see for understanding psychotherapy as part of a psychoanalytic curriculum?
Do you think it important that an analyst be familiar with the major methods of treatment outside psychoanalysis? This would include such things as pharmacological methods, cognitive therapy, behavioral techniques, etc.
Do you have electives as part of your training program? Could you describe them to us, and how they are established.
Candidates today have a refreshing independence of mind, tend to be more questioning, and expect more critical thinking in their courses. This has led to a more lively educational atmosphere. In some instances candidates have inspired faculties to reconsider their teaching methods. Candidates expect to participate more actively in the shaping of their education. This challenges traditional ways of relating to candidates and will undoubtedly lead to more informal and collegial relationships between faculty and candidates.
Medical candidates often have little dynamically oriented clinical experience, while non-medical candidates have had less experience in working with disturbed patients. Institutes frequently respond to this by requiring early psychotherapy experience, sometimes asking that it reach a level of proficiency before clinical analytic work begins.
We were surprised to find that most of our institutes seem to have had no trouble in providing training cases. However, many of those patients are taking psychotropic medications.
Lawrence Chalfin, M.D., has served as director of the NYU Psychoanalytic Institute, chair of The American's Committee on Institutes, and (most recently) chair of BOPS.
While this appears inevitable nowadays, our institutes do not, as yet, seem to focus on that new complication. Perhaps the issue of medication should be discussed more frequently in case conferences (and in the profession generally, so that we will know more about it).
There is little discussion of alternative methods of treatment. There is little interest in the range of alternative therapies or their possible advantages and disadvantages in relation to psychoanalysis.
We find little serious use of electives and post-graduate workshops, although some institutes are moving in that direction. Graduation should be seen more as a step in education rather than the end of it. Institutes confirm the great diversity in candidates' backgrounds.
Institutes are beginning to confront the need to educate about the plurality of theories. A few institutes are handling this in innovative ways. For instance, one institute offers a continuous case that is discussed successively by analysts with different orientations. There appears little interest in research, however, and scant effort to foster a research orientation. Problems of validation are mostly not discussed. The closest approximation to research training is the occasional requirement for a written paper.
While gathering data from the institutes and learning from their experiences, we have also had ongoing discussions within the committee regarding the key issues of psychoanalytic education. For example, in regard to the new pluralism, we wondered whether a good approach might be to teach the evolving theories of the mind and theories of technique from Freud up to the present in terms of the practical problems that each new direction was trying to resolve. Perhaps this would avoid reflex rigidity in reaction to the abundance of competing theories, while still preserving a steady psychoanalytic identity. This might help candidates to stay afloat in the sea of current controversy. Some institutes have already designed such courses. We might consider that a core skill is the ability to apply a sophisticated critique to alternative visions of clinical data. Implied here is the goal of learning to think about technique, process, and controversy in a critical, informed, and disciplined — but also imaginative — way.
In regard to technique, we considered what educational approaches could promote an ability to apply critical judgment to the many questions of methodology and choice. We reflected on the idea of examining the rationale for each customary feature of treatment in great detail and relating it to the raw problems that candidates can feel in their own practice. We thought that the past and current variants on Freud's plan could then be related to the candidate's real experience, and current controversy could be used to make even clearer what is at stake in choosing features of treatment.
We also thought that the basic treatment principles could be best illustrated in continuing cases presented by experienced analysts. This could be started early, and with the emphasis on the procedure rather than the patient's pathology.
As a corollary to the effort to sharpen critical thinking in regard to treatment methodology, we wonder if some education in general psychotherapy might be important to the curriculum, with case discussion designed to make psychoanalytic sense out of non-psychoanalytic and near-psychoanalytic treatments. This might enable candidates to use their psychoanalytic expertise to recognize the treatment forces they are calling on and to devise an apt style for each case. (This may be especially important as training cases have become less ideal.) At the same time, we reflected that mixing psychoanalytic training with psychotherapy training might jeopardize the development of a deep, well-anchored, psychoanalytic discipline. Relating psychoanalytic principles as applied, modified, or suspended to psychotherapy work of any and every sort that the candidates are conducting or might conduct, as well as to all of the exigencies of non-analytic treatment — urgent decisions, emergencies, family disasters, borderline torments — may deepen the understanding of the principles of “ideal” analytic treatment so that the principles will come to be known for their meaning, not their formality.
One area of our questions to the institutes concerned supervision. While supervision is often thought to be the place where educational goals come together around clinical dilemmas, theory, technical choices, personal talents, and the like, we wonder whether the goals and complexities of the supervisory process have been articulated as explicitly as they could be, particularly in relation to sharpening critical thinking. Could there be a more useful balance between guiding a particular case and highlighting principles of technique? Are there approaches that better facilitate the drawing out of the candidate's implicit theories, with a view to exploring and testing them? Are there approaches that make candidates more comfortable in confiding their personal difficulties with their patients? The Affiliates Council is avidly pursuing an interest in many of these questions. It is particularly looking into what kind of atmosphere within an institute most fosters and least inhibits creativity and critical thinking.
These are some of the initial directions Project 2000 has taken. We have been stimulated by our discussions both with the institutes and within the committee. These have generated a strong sense of excitement and enthusiasm that we hope will be communicated to the members of the organization in an ongoing debate about psychoanalytic education.
As our work proceeds, we will report to the Board and to our members our sense of what is occurring in psychoanalytic education today and our thoughts on what we might learn and consider. However, all our members have participated in educational programs at our institutes or elsewhere, and many have unique perspectives on the questions and the issues. We are vitally interested in hearing from the membership on these or any other relevant issues.