The Role of Psychoanalytic Institutes in Training Psychotherapists

The Boston Psychoanalytic Society and Institute founded the first psychotherapy training program among American psychoanalytic institutes in the late 1970s. The Advanced Training Program in Psychoanalytic Psychotherapy (ATP) became a respected and vital psychotherapy training program in Boston. Many ATP graduates have remained involved in the academic life of the institute.

The ATP was founded in part because of the diminishing presence of psychoanalysts (traditionally the main teachers for young therapists in training) as well as a diminishing psychoanalytic theoretical perspective in residency and other mental health training programs. Yet, to this day, paradoxically, psychoanalytic institutes do not play a leading role in training psychotherapists in the mental health community.

In spite of an obvious market, psychotherapy training programs both in Boston and at other psychoanalytic institutes in the U.S. have had similar recruitment problems. Despite the fact that many clinicians are interested in further psychotherapy training without becoming psychoanalysts, psychoanalytic institutes have not become the strong resource for psychotherapy training that one might expect.

We want to consider if there are systemic factors within the psychoanalytic establishment itself that contribute to the lack of vigor of psychotherapy training programs in psychoanalytic institutes.

Ambivalence and Confusion

One such institutional factor has to do with ambivalence and lack of clarity about the relationship of psychotherapy to psychoanalysis. Psychoanalysts have struggled to define this relationship in theoretical discussions over the years, but there is still no consensus. Is psychoanalytic psychotherapy a watered-down application of psychoanalysis, or is it a separate practice, based on psychoanalytic theory but with its own set of skills, its own goals, and its own way of applying psychoanalytic theories of the mind to clinical practice?

Theoretical confusion leads to ambivalence about the practice of psychotherapy. Often, psychoanalysts offer psychotherapy because either psychological or practical limitations contraindicate psychoanalysis: Thus, a limitation becomes the basis for recommending psychotherapy. In contrast, if the evaluating psychoanalyst arrived at a clear formulation of the patient's goals and suggested they indicate psychotherapy (even if the patient were “healthy enough” and could afford psychoanalysis), then the recommendation would be made on positive as opposed to negative criteria. As a profession, our ambivalence and confusion are such that we do not have clear, agreed-upon, positive (as opposed to negative) criteria for recommending psychotherapy.

Psychoanalysts understandably want to practice a craft that they have worked long and hard to develop. Analysts sometimes evaluate themselves on the basis of the number of analytic patients versus therapy patients in their practice.

If psychotherapy is defined as a watered-down application of psychoanalysis, offered on the basis of negative indications, psychoanalysts may have mixed feelings about predominantly practicing psychotherapy. When psychotherapy is a source of conflict and ambivalence in theory and in our professional self-image, this can be enacted when we set out to train psychotherapists. The enthusiasm with which psychotherapy training is marketed may be muted compared to psychoanalytic training. Psychotherapy training programs may be likely to hold an inferior place in the institutional hierarchy. In most institutes, assignments to teach in the psychoanalytic program carry greater status than teaching in the psychotherapy program, although many teachers personally enjoy teaching in the psychotherapy program. Usually, training analysts tend not to teach in the psychotherapy program.

Outreach to the Mental Health Community

The Boston Psychoanalytic Society and Institute have been active in reaching out to the wider mental health community by providing consultation and programs of interest and relevance. We have been offering a one-year fellowship in psychoanalytic psychotherapy as an introduction to psychoanalytic theory and practice. This fellowship has been very well attended. We have coordinated the curriculum with the ATP curriculum so that it can be a free-standing fellowship as well as serve as the first year of the ATP (Trainees may apply to the ATP after the fellowship and move into the second year of the three-year ATP.) The one-year fellowship has provided more interested applicants for both the psychotherapy and psychoanalytic training programs.

Ideally, the quality of psychotherapy and psychoanalytic training programs should be equivalent. Students may select one training program over another because of a variety of factors, including different professional goals, preference for a different manner of working with patients, or interest in different clinical problems. At the point of entrance to the educational community, there should be a conversation about the person's personal and professional goals and which program would best suit his or her professional aspirations. But as long as theoretical confusion and personal and political ambivalence regarding the relationship of psychotherapy to psychoanalysis persists, psychoanalytic institutes will not be able to represent psychotherapy training programs In the most positive and legitimate light.

As a profession, we need to discuss the relationship between psychotherapy and psychoanalysis in theory and practice, and psychoanalysts need to talk about their work as psychotherapists

There also needs to be open discussion about the value of psychotherapy training for institutes and its place in the institutional hierarchy. By discussing and clarifying these issues, we can be clearer about what we teach and can be better advocates for psychotherapy training, and thereby play a more vital role in the mental health community.