Recently, TAP received an announcement by a psychiatric group offering to introduce a psychodynamic approach to interested residents.
Introduce? Although the core of medical psychiatry was once not merely psychodynamic in orientation but solidly psychoanalytic, it is now axiomatic that psychoanalysis has lost its exalted status in psychiatric education. It has been replaced by biology and pharmacology, reinforced by managed care's emphasis on economics and efficiency and parallel insistence on short-term, research-based treatments.
This idea of “introducing” psychodynamics to residents led members of TAP's editorial board to wonder about the current place of psychoanalytic and psychodynamic ideas in psychiatry, psychology, and social work graduate education.
Psychoanalysis has been largely shut out of psychiatric academia, stemming the flow of potential analysts coming from psychiatry. But what about psychology and social work? The impositions of managed care and the emphases on biology have played their frustrating role in those fields as well, but there are additional factors.
In psychology doctoral programs accredited by the American Psychological Association, despite some important and outstanding examples to the contrary, there has been an increasing push toward a return to traditional areas of psychology. These include a strong programmatic content focused more on academic interests and experimental research and less on psychotherapy and a psychodynamic or psychoanalytic point of view. Short-term cognitive-behavioral approaches originating in psychology have preempted psychoanalytically oriented therapy in more and more university settings. Social work schools — again with notable and important exceptions — have moved their programs away from psychotherapy and toward societal, management, and policy issues.
Thus, the thrust in all three professional sectors has been to devalue psychoanalytic ideas and psychotherapy, particularly long-term dynamic therapy and psychoanalysis. While these trends have been playing out, the psychoanalytic movement has been divided, even within the APsaA itself. As we also know, there has been a history of rancor and inhospitableness between the APsaA and other groups.
Perhaps distracted by internal and inter-group differences, but also perhaps because of an inability to clearly assess and organize ways to deal with the shifting tides, psychoanalysts seemed for a long time relatively passive in the face of these seemingly inevitable and discouraging trends. In the last decade, however, there has been a renewed détente among psychoanalysts of every persuasion and professional grouping. Aware of the erosion of psychoanalysis in the public arena, there has been a palpable change in the degree of activity and integration both within the APsaA and in the larger psychoanalytic world. For the American Psychoanalytic Association, a new era of vitality has emerged through efforts to include other professional groups and respect for a broadening spectrum of psychoanalytic views. The APsaA has also made innovative efforts to investigate and communicate ways to turn the trend back toward appreciation of the richness that psychoanalysis has to offer.
“Renewed possibilities for analysts in residency programs suggest that the pendulum is swinging back toward valuing our central activities.”
Originally, the APsaA's Joint Committee on University and Medical Education had full responsibility for all matters pertaining to graduate education. In 1996, the association doubled its efforts by establishing a second committee, the Joint Committee on Graduate Education, mandated to develop projects designed to create a greater psychoanalytic presence in graduate psychology and social work programs. Having two committees permits a detailed focus on the philosophy, curriculum requirements, and specific needs of each discipline.
This special section of TAP attempts to take stock of the current role of psychoanalytic thought in the graduate education of the three largest mental health groups. Hinda Simon, a member of TAP's editorial board, focuses on the situation in social work schools. She highlights the dissonances between the goals of most social work curricula and a psychoanalytic perspective. I am also a member of the editorial board and discuss psychology doctoral programs, with input from interviews of psychology colleagues associated with graduate education and survey information from the Committee on Graduate Education. Lisa Mellman, who among her many “hats” is associate director of the Psychiatry Residency Program at Columbia University, brings us exciting news about the possibilities for increasing psychoanalytic input into psychiatric residency training.
In many respects, the news from the three reports is not unexpected. Yet there are surprising and promising new initiatives. For example, renewed possibilities for analysts in residency programs suggests that perhaps the pendulum is swinging back toward valuing our central activities. Now it will be up to those analysts who are appropriately aligned to support the efforts. Psychologists at one university have taken on the challenge of making psychoanalysis meaningful within new constraints; at another, they have created new opportunities that fit well with psychoanalytic expertise. From social work we learn that two years of training leave little room for clinical interests, pointing up the need for further post-graduate clinical development of a psychoanalytic nature.
Eric Marcus, chair of the Joint Committee on University and Medical Education, said that every student in the seminar he teaches at Columbia who comes to understand psychoanalytic principles will potentially affect hundreds of others. Stephanie Smith, chair of the Joint Committee on Graduate Education, emphasized the importance of encouraging collaboration between analysts and academic faculty, including attempts to draw graduate faculty into closer contact with the APsaA. Her committee invites graduate faculty to participate in scientific programs and welcomes graduate faculty as full and active members of the committee. The committee has also designed a project to explore multiple methods for arranging elective credit within graduate programs for students taking institute extension courses, studying with psychoanalysts, and the like.
In December, at the New York meetings, Smith and Marcus will co-chair a new and ongoing interdisciplinary discussion group, “On Teaching Psychoanalytic Views of Mind: Forum for Analysts and Academic/Professional
Faculty Teaching and Supervising in Graduate Psychiatry, Psychology, and Social Work Programs.” Also at the meetings, the Joint Committee on Graduate Education will co-sponsor a presidential symposium with Dick Fox on psychoanalysis and graduate social work education. Symposium co-chairs are Helen Rosen, committee co-chair for social work, and committee member Ann Abbott, past president of the National Association for Social Work.
The challenge is to get the word out through faculty already in place and to encourage younger psychoanalysts to turn their energy toward becoming the psychoanalytic educators of tomorrow. Then psychoanalysis can again be taught through graduate curricula, and faculty and students can again learn psychoanalytic ideas.