Cleveland's Psychoanalytic Psychotherapy Program (PPP) got off to a great start in 1990, but by 2000, it had run out of steam. Two years later, it was restarted. Why and how did all this happen? That's what this essay by one participant will attempt to explain in the hope that these reflections may be of interest and assistance to other communities who are past the start-up phase.
An enthusiastic group of experienced analysts and candidates (the Steering Committee) set up the original program as a didactic seminar, two hours of class each week for two years. Well taught by excellent analysts, the program graduated some thoughtful clinicians, a number of whom continued in postgraduate study groups with senior analysts. Another cadre figured heavily in the formation of our local chapter of the Association for Psychoanalytic Thought (APT), a group of motivated professionals who meet to explore psychoanalytic subjects.
In the heady climate of new outreach activities in the '90s, the program's co-directors enjoyed the admiration and support of the broader Cleveland Psychoanalytic community Related developments in our group, similar to outreach efforts across the country were a low-fee treatment clinic, a new foundation, the formation of APT enhanced opportunity for candidates, and major leadership roles for non-analysts. Those were exciting days for the overarching Steering Committee, but the prospect of change brought anxiety and a sense of vulnerability to our hitherto sheltered psychoanalytic organizations. Furthermore, the outward expansion of programs stressed a weak, volunteer-driven infrastructure in the Society. Analysts seemed to be doing all the copying, filing, and organizational busywork themselves.
In retrospect, it appears we worked both inefficiently and with some fear, among other things, of liability and lawsuits. Because nobody wanted to be the target of litigation, there was a determined, if quiet, effort to avoid the prospect of training therapists who might then assert kinship. For example, some esteemed colleagues not involved with PPP had concerns that therapists participating in the program would represent themselves as analysts. Consequently, the program offered no supervision and no membership opportunity for graduates. Furthermore, liability worries at the Steering Committee level led to abandonment of an initial plan to refer cases from the low-fee clinic to PPP students, reducing still more the integration of the students into our community.
Despite our defensive response to organizational anxiety, a series of solid classes began every other year But—PPP lost momentum after only four classes. That fourth class (1999-2000) was small and attrition was high—only three of the initial six students managed to complete the course. After this unsatisfying experience, the program stalled. Lack of enrollment discouraged the two leaders from continuing; our analyst faculty seemed worn out and busy with other interests. It became evident that not a single student had gone on to full psychoanalytic training.
Clearly, something was not working. Indifference to the program's future set in. With the passing months came the realization of larger organizational problems. As a result, the analysts shifted their overall focus from the continuation of problematic programs to a new strategic planning effort. Through this process, recognition of our central weakness led to a merger of our Society and Institute into the Cleveland Psychoanalytic Center, complete with the hiring of an executive director with marketing and management know-how.
Simultaneously, new energy came from APsaA. By happy coincidence, a member of the Cleveland Psychoanalytic Center was on the Committee on Preparedness and Progress (COPAP). This committee reviews waiver requests from Institutes that want to provide full clinical training to those without so-called terminal degrees (i.e., Ph.D., M.D., D.S.W.), mostly M.S.W.'s. From this, two key things became apparent: (1) Supervision is a vital part of a psychotherapy course, as it provides a convincing experience that overtime brings identification and often a wish for further training; (2) COPAP and its parent Board on Professional Standards had adopted formal policies defining acceptable minimal immersion for master's level applicants that precisely matched the two-year PPP program, provided it included supervision. In short, there were national as well as local reasons to bring in a supervision component.
We instituted three other innovations:
The Center's Executive Committee recruited a non-analyst graduate of PPP to be program coordinator, with a $1000 yearly honorarium and a full tuition waiver for a repeat of the course. Coordinator Jacqueline Goodin has proven herself to be of immense value, bringing savvy and determination to re-inspire the PPP. Working with an active Analyst Advisory Committee, she keeps our focus on the students' experience, adjusting the course in response to frequent feedback.
We recruited two non-analysts as guest faculty. These experienced teachers, who were members of our local APT chapter, volunteered to co-teach segments on neurochemistry, psychopharmacology, and sexuality. Neither of these talented people is formally trained in psychoanalysis, but both are highly regarded and sympathetic colleagues. They collaborated with and, challenged the analysts to renewed effort.
We revised the curriculum to focus on practical matters, especially technique and adult clinical issues by shifting away from an emphasis on child development and psychoanalytic theory.
Richard Lightbody, M.D., chairs APsaA's Committee on Societies and Centers.
In sum, we introduced a series of changes for a renovated venture in 2002: a requirement for weekly individual supervision; a non-analyst coordinator; a reconstructed curriculum; and guest faculty. Additionally, we benefited from the Center's revised organization and executive director.
We had 20 inquiries for the current class. Ultimately, we enrolled a qualified class of nine, mostly experienced social workers, including one Ph.D., a Ph.D. student, and two M.D.'s for spice. One of the psychiatrists was a visiting professor from Korea whose local stay was only one year. We made room for him because of his wish to learn how to teach psychotherapy at the postgraduate level. We mail the second year's reading material to him in Korea. Adapting our rules to the wishes of students seemed a practical ideal.
Looking back on the first year of the resurrected PPP, we feel the program is doing well. Two of our students were finalists in APsaA's Fellowship Program, and now have senior analysts as mentors. Nearly half of the students have shown at least some interest in psychoanalytic training. Supervision is enormously popular, as reflected in student evaluations. We have kept PPP “in front of” the Center's membership with frequent communiqués, and have polled students often in order to tailor the program to their learning goals. Specific feedback is immediately relayed to the faculty after each teaching segment; global assessments of the program influence near and distant decisions.
We are beginning to recruit our next class, scheduled to start in September 2004. Although every current student came by word of mouth, we have developed a publicity brochure. With a streamlined decision tree, we are able to get done that which had previously been complex and anxiety producing. And we are already planning for succession of leadership. If we have learned anything, it is that new appointments are essential for continuing energy and ideas.