Until very recently, the development of new psychoanalytic training centers in the United States has followed a simple pattern: sponsorship by an institute accredited by the American Psychoanalytic Association. Since the settlement agreement of the 1989 lawsuit against the American and the International Psychoanalytical Association (IPA), other avenues have become more prominent and of interest.
Although the IPA also uses the sponsorship method, another route is available to form a component society of the IPA. A committee of three analysts is selected based on their experience in psychoanalytic education and representing an international view of training. This committee shepherds a study group through provisional institute status to component society. Initially, a sponsoring committee has full responsibility for the training program. Making frequent visits, it oversees the selection of candidates, their advancement, the selection of training analysts, the establishment of the curriculum, the drafting of constitution and bylaws, etc. The committee is responsible for transmitting the standards of the IPA. Once the study group has grown and has established its program, a site visit is conducted to determine its suitability for advance to provisional society. At this juncture the sponsoring committee becomes a liaison committee that follows the progress of the provisional society as it assumes the full burden of running a training program. After a minimum of four years, the provisional society may apply for a final site visit to determine if is ready to become a component society.
The details of these procedures are formalized in the IPA procedural code. In the sponsoring committee model, the fact that the committee comprises members from different societies guarantees that multiple viewpoints about psychoanalytic education will be melded into a whole that embodies IPA standards but is adapted to local circumstances. It is ideally suited for situations in which the sponsoring institute model cannot be applied. For example, in eastern Europe the breakdown of communism spawned an intense interest in psychoanalysis, but there were no established institutes to sponsor these interest groups. The committee model was ideally suited to the situation because innovative training methods had to replace the procedures of the standard, established model. The sponsoring committees were constrained to preserve the performance standards of the IPA without being committed to any single means of achieving this goal. These committees had to focus not on replicating educational methods that were effective in a sponsoring institute, but on a particularly intense evaluation of the outcome of innovative methods that replaced the standard model.
The IPA Committee on New Groups has made a great many innovations in training that have been largely unknown outside the committee and the Executive Council of the IPA. The committee was delighted when Otto Kemberg, president of the IPA, offered it the opportunity to present these innovations and findings to a special joint symposium of the Executive Council, the House of Delegates, and invited guests.
The symposium took place on December 14, 1997, in White Plains, N.Y., to consider the topic “Psychoanalysis at the Crossroads: The Challenge of Developing New Institutes.” In addition to considering innovations in establishing new institutes, we compared these innovations with the practices, policies, and ideals of analytic institutes around the world.
The meeting was characterized by candid discussions that made evident the great heterogeneity of educational practices already extant throughout the component societies of the IPA. The surprising revelation was that the innovations the new groups presented were already a part of established practice in one or another IPA institute.
The major challenge to the traditional form of analysis (four or more sessions per week on separate days) was that of concentrated analysis (more than one session per day, so that a total of four sessions occur within three days). For many decades, the selective use of concentrated analysis has been employed to establish new institutes both in the United States and in other countries. At the symposium, those in favor of concentrated analysis based their opinion on a variety of experiences. Some had done concentrated analysis; some had supervised such analyses; and some were aware of continuous, documented clinical experience over the last thirty years in Brazil. Advocates of concentrated analysis believe that candidates trained in such an analytic process succeed in establishing an adequate identity as an analyst.
Those who spoke against concentrated analysis expressed concern that transference considerations, defense interpretation, degree of regression, dream analysis, and similar technical issues could not be explored adequately and that the resulting analysis would be significantly different from traditional analysis. Some spoke of the “political implications” of concentrated analysis. They were concerned that the pressure to train candidates from a distant city might become the reason to use concentrated analysis before outcome studies proved its value. Those who believed that its value has already been established disagreed that it represents a “political” solution to a scientific question.
Advocates and opponents agreed that it would be premature to establish concentrated analysis as an equal alternative to traditional analysis in all circumstances. All believed that the procedure should be applied to selected applicants and its outcome studied by appropriate IPA research bodies.
Although the usual form of outcome evaluation of an analysis — supervised work — supports the impression that concentrated analysis can produce capable analysts, it became evident during the dialogue that most people did not believe these individual impressions were sufficient to assure the skeptics. This led quite logically to the observation that neither the traditional model nor the model of concentrated analysis has become the object of outcome-based research. Symposium participants expressed concern that institute graduates who had a traditional analysis could be looked upon as superior to those with an experience in concentrated analysis.
David M. Sachs, M.D., is a clinical professor in the Department of Mental Health Sciences of Hahnemann University and a training and supervisory analyst for the Philadelphia Association for Psychoanalysis. This article was based on a report from the symposium task force committee, which included Stephen K. Firestein, Roy Schafer, and Barbara Stimmet.
The IPA would not want to create such long-term practical and political problems, and research was considered a way to validate clinical impressions.
Other innovations in analysis were considered. For example, periods of traditional analysis combined with periods of concentrated analysis have been tried, particularly in establishing new groups in eastern Europe. It was debated whether or not these variations created an adequate analytic experience. All agreed that the outcome of these analyses should be evaluated in an open-minded fashion.
The issue of three-times-a-week analysis was addressed when the experience of the Paris Society was described. Thrice-weekly analysis is routine, and the Paris Society firmly believes that it is equivalent to analysis four or five times a week. Concentrated analysis has not been undertaken at three times a week. Analyses need not be conducted by a training analyst, so long as the analyst is a full member of the Paris Society. In interesting contrast, the French Psychoanalytical Association retains the traditional form of analysis but has abolished the category of training analyst and accepts analyses from outside its membership. This society emphasizes careful evaluation of the candidate's readiness to matriculate and undertake analytic training, rather than on the credentials of the person doing the analysis. Since the New Groups Committee adheres to the four-times-per-week standard, these methods in established institutes were considered at least as innovative as those so far employed by the committee. There was active discussion about the pros and cons of this training scheme.
A presenter described an interactive model in which exchanges between supervisor and supervisee involving mutual education were contrasted with the more classical model of the supervisor as objective observer and commentator. In addition to protecting the patients' interest relative to the inexperience of the candidate, the supervision furthered the socialization of the candidate as a member of the analytic community. Without a need to foster and preserve the transference, the supervising analyst could introduce candidates to colleagues at meetings, recommend avenues for professional advancement, and act in the general role of mentor. In addition, the candidate would be exposed to a manner of conducting an analysis other than that experienced in the personal analysis. Another point emphasized was the value of having supervisors from groups with other orientations participate in training through symposia and other methods, thus exposing candidates to a broad range of psychoanalytic methods.
There was some discussion of alternative methods of supervision. These include communication by telephone and sometimes by fax and e-mail. Although still largely untested, the idea of “concentrated” supervision, in which several sessions are held over a weekend, was raised; no one opposed trying this on an experimental basis. All agreed that without some face-to-face contact, supervision cannot be fully effective. Symposium participants hoped that innovative methods would be studied carefully by appropriate research undertaken by the IPA. There did not seem to be a widespread practice of preparing supervisors to be supervisors, although some institutes are working on such projects.
An enthusiastic case was made for centering didactic analytical training in university settings, where enrollment would not be limited only to analytic candidates. One advantage would be the awakening of interest in psychoanalysis as an intellectual discipline. Reaching the larger community through an academic community is a traditional way to spread knowledge of new fields of study to the general public.
The proponents of the university setting emphasized that academia provides a rich source of experienced teachers who are skilled in imparting basic theoretical ideas and therefore could do the same for the basic theoretical ideas of psychoanalysis. There is a great advantage in exposing candidates to interdisciplinary subjects that can give them a broader perspective for their future psychoanalytic work. Counter-arguments were advanced that didactic training by teachers other than those actively engaged in clinical psychoanalysis could not convey the material adequately because of a lack of personal, clinical examples.
A few attendees suggested after the meeting that placing an analytic institute within an academic environment might make it vulnerable to the political vicissitudes of academic institutions. Another proposal was for the IPA to formulate a general didactic program that could be taught at various psychoanalytic centers, with candidates allowed to select courses through different institutes in order to broaden their perspective on the field.
The didactic program is applied in many different forms throughout the world. Some established institutes do not require candidates to follow any program strictly, but rather are prepared to assess the general knowledge of each candidate. This is consistent with an attitude in which the decision about readiness to practice analysis is made when candidates apply for a final evaluation.
One argument was over whether teaching psychoanalytic psychotherapy to candidates should be a regular part of analytic training. Proponents argued that analysts are devoting more and more time to practicing psychoanalytic psychotherapy. Although such estimates vary greatly with the culture, many analysts report a sharp decline in potential analytic patients. These proponents of teaching psychoanalytic psychotherapy believe they would have benefited from some formal training. Opponents were concerned that such training within institutes would dilute interest in learning psychoanalysis proper, and perhaps even distract from the practice of psychoanalysis. Part of their argument was a strong belief that psychoanalysis has general applicability over a wide range of diagnoses, and that the proponents of psychoanalytic psychotherapy were narrowing the range of application of psychoanalysis. Others argued that certain forms of problems — perhaps those involving psychosis and some forms of personality disorders or borderline difficulties — might warrant psychoanalytic psychotherapeutic approaches.
Some recommended that analysts teach psychoanalytic psychotherapy either as adjunct programs in their institutes or elsewhere in the community. The goal here is to promote psychoanalysis among mental health professionals. Those opposed wondered whether people who had not been analytically trained could do psychoanalytic psychotherapy. Others believed that psychoanalytic psychotherapy could be taught to non-analysts and that the spread of psychoanalytic ideas justified it. It was questioned whether training for psychoanalytic psychotherapy constituted desirable preparation for psychoanalytic training itself. (Advocates claim that it has no deleterious consequences for the practice of psychoanalysis; opponents claim that it interferes with the acquisition of an analytic point of view.) It was acknowledged that many forms of psychotherapy are taught and practiced in all regions. The question was asked, should the IPA remain formally absent from this arena, or should it present its own way — if there is a single definable way — of doing psychotherapy so that it can take an active part in the debate both within and outside its institutes?
It is clear that there is astonishing diversity among our members and our societies in the ways they train and teach their candidates and respond to their communities. The word “standards” is probably outmoded if it is intended to refer to a specific form of training; it should be replaced with such words as “guidelines” and “models of training” that give considerable latitude to the different procedures used among IPA component societies. All symposium participants believed that the IPA needs to develop some way of understanding what a well-trained psychoanalyst looks like and to accept that there are many ways to reach that goal.
The innovations of the New Groups Committee were matched by the spontaneous innovations of existing IPA training programs. Constructively adapting these innovations to each setting would be the best way to develop psychoanalysis in places where people are eager for such education. In this way the IPA can balance the financial, intellectual, and educational needs of its existing groups with the needs involved in promoting the growth of psychoanalysis. The greatest obstacle to such balanced growth is the belief that the traditional means used to train competent psychoanalysts need no modification. Clearly, no one model will be best in all regions where new and exciting potential for psychoanalysis exists.
A remarkably beneficial outcome of the conference was the impressive and open sharing of points of view. Colleagues from around the world described the details of the educational model in their own communities. Members of all facets of the IPA administration attended the symposium together with invited guests who represented additional constituencies. This resulted in the widest possible geographical distribution of participants. A question repeatedly asked was how we could begin to teach and learn from one another in different parts of the world.
The IPA Committee on New Groups is interested in the reactions of American analysts who have been unfamiliar with these exciting developments in the spread of psychoanalysis. The interest in psychoanalysis continues to develop in other parts of the world, and new ideas will be needed as technology makes other innovations possible. If anyone cares to share ideas and/or has an interest in the work of this committee, please send them to the author in care of this publication or directly by e-mail to .
Roster Correction
Richard H. Brent's name was inadvertently listed in the “In Memoriam” section of the American Psychoanalytic Association roster. The American is pleased to report that Brent is alive and well. His name and address are correctly listed in the members' section of the roster. We regret the unfortunate error.