When I presented my paper “Some Thoughts Regarding Innovations in Psychoanalytic Education” to the Executive Council of the International Psychoanalytical Association in Puerto Vallarta, Mexico, in January, there was general agreement that the topic was timely. This article summarizes the discussion that followed the paper.
Many institutes have experienced a decrease in applications of psychoanalytic candidates and a shift in the professional backgrounds of candidates that may have implications for both training and the position of psychoanalysis in Western society. There appear to be fewer candidates from psychiatry and clinical psychology, and relatively more from the humanities, social work, and nursing.
The practice of graduates of psychoanalytic institutes has also changed. In many countries, psychoanalysts carry out only a small number of analytic treatments, and most of their practice is dedicated to psychotherapy. This common experience led to several questions:
Are our methods of education adequate to the tasks that our graduates have to perform?
What are we educating our candidates for?
What is the relationship between psychoanalysis and psychotherapy, and are we paying due attention to this issue in psychoanalytic education?
Several council members pointed to the inevitability of conflicts between institutional dynamics, on the one hand, and the reactivating of intrapsychic conflicts as part of the experience of analytic training, on the other. An implicit controversy arose between those who consider such conflicts unavoidable and those who believe that a sophisticated concern for the organizational and administrative functions of the psychoanalytic institute may significantly reduce these conflicts.
With diverging models of psychoanalytic theories and technique, we need ongoing evaluation of the divergence and an ongoing effort to establish or re-establish a core “common ground” while tolerating both divergence and controversy in theory and technique.
This discussion led to the issue of “flexibility vs. standards.” The term “standards,” theoretically referring to levels of performance, is used instead to refer to requirements for graduation. It is also used as a code word in the discussion of the relative merits of three sessions weekly vs. four in training analysis and analytic control cases. The council generally agreed that frequent sessions are desirable for at least part of candidates' personal analysis and for part of their experience with patients. Such considerations should be part of an effort to establish flexible training requirements.
The issue of selecting training analysts and whether training analysis is or should be different from ordinary psychoanalytic treatment evoked a broad range of responses. Some council members would keep the present training analyst system, leaving to education committees the discretion of appointing training analysts; others would prefer to abolish both the status and the functions of the training analyst, totally separating candidates' personal analysis from the educational structure and letting candidates choose their personal analyst freely within the psychoanalytic society. A middle view stressed the need to have some quality control over candidates' personal analytic experience, based perhaps on the training analyst's number of years of clinical experience after graduation, an examination of those applying for the training analytic function, or an evaluation of training analysts' experience and commitment to psychoanalysis as demonstrated by active-participation in clinical and theoretical seminars, supervisions, and case presentations.
All agreed, however, that the function of training analyst should not be linked to a system that would restrict the number of training analysts while assuring a “captive market” for the elite of the psychoanalytic institute. Some expressed concern that some training analysts developed an unrealistically optimistic view of the profession because their caseload is assured by a supply of candidates — in contrast to the dearth of analytic cases for the general membership of many societies. There are advantages to separating the training analytic function from supervision and seminars and selecting supervisors and seminar leaders separately from the training analyst functions.
The discussion returned to the relationship between psychoanalysis and psychotherapy. A strong minority opinion was that the more severe borderline and psychotic cases that tend to be treated with psychoanalytic psychotherapy rather than psychoanalysis should also be treated with standard psychoanalysis. This included an implicit appeal to “upgrade” our psychoanalytic technique to treat these difficult cases with analysis, rather than “diluting” our technique to psychotherapeutic methods. The majority opinion cited the reality of clinical practice in many countries, where psychoanalysts choose to treat borderline, schizophrenic, and major affective disorders with methods other than psychoanalytic proper.
Discussion participants agreed that we need more flexible educational methods. These should not be seen as opposing high standards of clinical practice; there may be alternative routes to an optimal psychoanalytic education. All agreed that a high frequency of sessions was desirable in the treatment of both control cases and candidates in personal analysis. There was consensus that the discussion around “three vs. four or five” sessions did not address the complexity of exploring alternative systems of psychoanalytic education. We do not pay enough attention to the post-graduate education of the psychoanalyst. Capacity for personal development after graduation should be a criterion for graduation, as well as a potential to be explored and fostered.
All agreed that we need to radically update the curriculum of psychoanalytic institutes, bringing in experts from other fields. The only disagreement here was on how much to emphasize the biological vs. the social sciences at the boundaries of psychoanalysis.
Otto Kernberg, M.D., is completing his term as president of the International Psychoanalytical Association. His most recent book, Ideology, Conflict, and Leadership in Groups and Organizations, was published in 1998 by Yale University Press.
Other matters for attention are (1) the possibility of developing masters' degrees and doctorates in psychoanalysis in universities and (2) the dialectics of psychoanalytic science being taught at universities while clinical training is carried out in psychoanalytic institutes. Psychoanalysis needs to rejoin the university, and psychoanalytic institutes have to adjust to live with the ambiguity and complications that may be the price of psychoanalysis's acceptance in academia.
One concern that emerged at several points during this discussion was the extent to which we are preparing candidates for the reality that they are going to face, in contrast to providing them traditional ideas and methods. Psychoanalytic education needs to take place in the professional and social environment to avoid isolation and obsolescence.