APsaA societies and institutes have been offering psychotherapy training since 1977, when the first program was established in Boston. Even at that time, there had already begun a progressive decrease in long-term psychotherapy training in all disciplines and an increasing emphasis on alternative therapies such as brief psychotherapy, cognitive-behavioral therapy, and psychopharmacology. This trend has accelerated in recent years. A motivation for starting the psychoanalytic psychotherapy programs was that the majority of psychologists and social workers were ineligible for full psychoanalytic training, since APsaA was primarily admitting psychiatrists. By 1999, there were 19 programs for adult psychotherapy training and 5 for child psychotherapy training associated with institutes and/or societies. Today, the situation in mental health education is even more dire. Many training programs in psychiatry, psychology, and social work offer little or no training or supervision in psychodynamic psychotherapy It may well be that psychoanalytic societies and institutes will become the guardians of this important art.
This special TAP section will focus on problems in developing psychotherapy training programs. Talking with training directors around the country, we found a remarkable similarity of concerns and developmental problems. In starting psychotherapy training programs, typically there are fears that such programs will drain off candidates for full training, exposure to litigation will increase, and graduates will “pass themselves off” as analysts. In fact, none of these have proved to be major problems. On the contrary, psychotherapy training programs have become a major source of new candidates. Perhaps a more fundamental barrier is confusion and controversy about the relationship between psychoanalysis and psychotherapy.
As Saporta and Pollack discuss in their article, we are not clear if psychotherapy is a type of watered down psychoanalysis or a discipline in its own right. A parallel tendency is to see teaching psychoanalysis to candidates as more prestigious than teaching psychotherapy. Often, teaching psychotherapy courses is viewed as a career step toward institute teaching, rather than valuable in its own right.
In starting psychotherapy training programs, typically there are fears that such programs will drain off candidates for full training, exposure to litigation will increase, and graduates will “pass themselves off” as analysts.
The article by Lightbody highlights typical problems in the evolution of training programs. Beginning programs struggle with the question of whether to offer an educational experience or training. Full training would include supervision, evaluation of students, and often requires personal therapy or analysis in addition to courses. Programs must clarify if their primary purpose is to be a feeder program for full training or to improve the practice of psychotherapy in the community. There is often a competition for institute faculty between candidate training programs and psychotherapy programs. Questions arise about which professions to accept, what level of experience to aim for, and how to integrate a variety of students. Additionally, programs experience various recruitment and marketing problems as well as shifts in enrollment over time.
Another major difficulty for societies and institutes is the fate of graduates of programs. Graduates usually form strong identification with the training program and wish to retain some affiliation. How welcoming are societies to non-analytic clinicians? Solutions vary around the country: inclusion in general membership, formation of allied associations for psychoanalytic thought, ongoing study groups, and use of some graduates as teachers in the training program.
The article by Schmidt illustrates that child training programs face many of the same tensions as adult training programs. One can see the same thread of conflict between the goals of psychoanalytic and psychotherapy training.
To explore this topic further, an excellent information resource is the Psychotherapy Training Workshop chaired by Alan Pollack and Sally Rosenberg at the annual meetings. As this TAP goes to press, APsaA is beginning a new psychotherapy initiative with a task force, to be chaired by Dick Fox, charged with the task of consolidating and enhancing the organization's engagement with psychoanalytic psychotherapy.
Robert S. White, M.D., is a member of the TAP editorial board. He is the president of the Western New England Psychoanalytic Society and an assistant professor of psychiatry at Yale University. Caryle Perlman, M.S., also a member of the TAP board, is on the faculty of the Chicago Institute for Psychoanalysis and the Institute for Clinical Social Work.