The Child and Adolescent Psychotherapy Training Program (CAPT) of the Chicago Institute for Psychoanalysis, which began in 1962, trains a small number of mental health professionals from various disciplines to conduct individual child and adolescent psychotherapy. The changes in the CAPT program over its 40-year history reflect the shifting landscape of the mental health delivery system, the broadening of training opportunities for mental health professionals, and the tensions in psychoanalytic institutions between medical and non-medical practitioners, between adult and child clinicians, and between psychoanalytic and psychotherapy training.
When it started, the Child Therapy Program (CTP), as it was then called, trained social workers who were sponsored by the agencies they worked for. Agencies provided tuition support, time off for classes, and supervision. Since its establishment, 116 of the 148 students who entered the program have graduated. CAPT graduates work often in supervisory or administrative leadership positions, in mental health clinics, social service agencies, schools, and medical settings as well as in private practice.
The Child Therapy Program was originally designed to meet several goals: to train child therapists; to produce a new generation of child therapy supervisors and teachers; and to develop a model educational program for child therapists. As agencies that provided services to children sought more formal, in-depth teaching of child therapy, the Institute, whose faculty often consulted at these agencies, seemed a natural location for this training. In reality, social workers in agency settings provided most of the direct individual psychotherapy to children, many of whom suffered from significant emotional disturbance and family dysfunction. CTP was an innovative response to the existing situation. These children's mental health needs, combined with the lack of systematic child therapy training, led the Institute to initiate CTP, with support from the National Institute of Mental Health (NIMH) and community funding. CTP represented a compromise between those who supported a child analytic training program for lay analysts, like the European model, and those who believed the child analytic domain should be restricted to psychiatrists.
The foundation in clinical work with children also taught students how to think conceptually in ways that can be broadly applied to other forms of intervention with children and adults.
From its inception, the curriculum offered intensive, rigorous training. It purposely allowed for an integrative process over time, as the material was repeated, increased in complexity, and examined in lecture, seminar and supervisory formats. Admissions criteria were stringent, suitability for learning and for treating children was carefully assessed, and a personal analysis was required. About 10 years ago, this requirement for analysis was modified to include an intensive psychotherapy alternative. The courses, meeting six hours a week over a four-year period, covered psychoanalytic theory, normal development, psychopathology, the therapeutic process with children, adolescents and parents, and clinical technique. The clinical component of the program included supervision of 4 treatment cases and 25 diagnostic evaluations of children and adolescents with varying problems and diagnoses.
The educational philosophy embodied in the process and requirements, carefully thought out by the program organizers, laid the groundwork for an extraordinary learning experience. Students become immersed in their clinical work and develop strong professional identities as psychoanalytically oriented child psychotherapists.
Peter Shaft, a 1989 graduate, says, “It was a privilege to participate in that exciting, scary environment. It was unlike anything else because of the opportunity to learn, to listen to unfolding process, to tolerate not knowing, and to acquire an understanding of transference and countertransference dynamics with a faculty who facilitated that kind of learning.”
Judith Schiffman, a 1980 graduate, echoes these sentiments, “The foundation in clinical work with children also taught students how to think conceptually in ways that can be broadly applied to other forms of intervention with children and adults.”
When CTP started, it attracted committed students and earned the respect of the community because of the quality and depth of its training. There were few viable options then for post-graduate clinical training in either adult or child psychotherapy Doctoral programs emphasized research and policy; supervision and training within agencies was increasingly limited. The Child Therapy Program quickly became the standard for excellence within the Chicago mental health community. Over time, some modifications in the program have been made; for example, the requirement for agency sponsorship was dropped in the early 1970s. CAPT remains one of the few routes available for a comprehensive, integrated training program that emphasizes introspection, unconscious
Erika Schmidt, M.S.W., is a candidate at the Chicago Institute for Psychoanalysis and on the faculty of the CAPT program. She is also the coordinator, Child and Adolescent Specialization, Institute for Clinical Social Work, and associate editor, Child and Adolescent Social Work Journal.
meaning, subjective experience, and respect for therapeutic process.
Within the Institute, however, there remains some ambivalence toward CAPT. Some have been skeptical, and at times openly antagonistic, about the Institute educating psychotherapists. This reflects similar conflicts within American psychoanalysis in general regarding non-medical therapists and the training of psychotherapists versus psychoanalysts. Though designed for agency personnel as education in child psychotherapy, not child analysis, many analysts within the Institute opposed such an educational offering, because it disturbed the mental health hierarchy.
Considerable effort has been made to distinguish CAPT as a corollary modality for teaching about different forms of intervention for different problems and populations. The perceived economic threat posed by CAPT graduates and students competing with analysts for a limited number of patients constituted a strong undercurrent to the discussion of training issues. In reality, the broader question has to do with the mission of the Institute and the conflict between those who see its function as the education of psychoanalysts and those who envision the Institute as a center for the study of psychoanalysis in many applications and a source for services to the community.
As a group, CAPT graduates and students have been an influential, potent force for psychodynamic psychotherapy within the community. They are committed to a psychoanalytic mode of thinking and devoted to providing psychoanalytic psychotherapy to a wide range of patient populations in varied settings, from child welfare agencies to private practice.
When the requirement for analysis was amended to include intensive psychotherapy as an option, the rationale was to widen a diminishing applicant pool. But the change also addressed an underlying tension within the relationship between the analytic Institute and its psychotherapy students. Requiring a personal analysis to assist the therapist in dealing with countertransference and the stresses of doing psychotherapy was sometimes perceived as psychoanalysis being considered a better kind of treatment rather than one with different aims. Questions about what constitutes excellent treatment and the boundaries between psychoanalysis and psychotherapy are not yet fully resolved.
As psychoanalysis has lost preeminence in the mental health field and training opportunities in other environments have opened up, the role of CAPT for clinical training has changed accordingly. Some students who would have gone into CAPT are now eligible for full analytic training. Five CAPT graduates have entered analytic training. Doctoral programs with strong clinical components are now available as are training programs in adult psychotherapy. Many CAPT graduates, who know what excellent clinical training consists of have been instrumental in developing alternative training opportunities. Some examples are Joe Palombo, Louise Saltzman, and Woody Faigen at the Institute for Clinical Social Work, Judith Mishe at the New York Univerity doctoral program, and Judith Schiffman at the Northwestern Genetics Counseling Program.
At the present time, CAPT classes are smaller, the students are explicitly committed to the practice of child therapy, and they enter the program with a more eclectic educational background and less familiarity with psychoanalytic concepts. According to Director Colin Webber, “CAPT can thrive in this new training environment because of its unique emphasis on clinical child and adolescent psychotherapy training.”
[Author's note: Thanks to former and current directors, Joe Palombo, Barrie Childress, Barrie Richmond, and Colin Webber, for answering many questions about the history and aims of CAPT.]