Psychoanalysts spend much of their professional time doing psychoanalytic psychotherapy. They treat more patients using a psychotherapy model than the formal psychoanalytic one and in most analysts' caseloads psychotherapy hours far outnumber analytic hours. In conducting these psychotherapies and in supervising psychiatric residents, graduate students, and non-analyst colleagues, analysts use concepts, techniques, and skills learned during their psychoanalytic education. Most analytic practitioners consider psychotherapy a major part of their professional careers, yet psychoanalytic psychotherapy is not officially recognized in our institutions and organizations.
Although many of our societies and institutes have developed very successful psychotherapy programs, our analytic organizations continue to reflect an “upstairs-downstairs” relationship between psychoanalysis and psychotherapy. As part of our idealization of Sigmund Freud, we have institutionalized his metaphor of psychotherapy as the alloy of the pure gold of analysis with the base metal of suggestion. In turn, this group idealization impacts on our identity as psychoanalysts. “Real” analysts do psychoanalysis (i.e., four to five times a week on the couch) not psychotherapy.
The psychotherapy initiative is a concerted effort to address some of these distortions and acknowledge that psychoanalytic psychotherapy has been one of our proudest and most productive achievements. It is certainly time to elevate it from its status as the stepchild of analysis and make it a member of the analytic family. The Task Force on Psychotherapy has been appointed to spearhead this mission to expand APsaA's efforts on behalf of psychotherapy in education, scholarship, and membership. I am chairing the Task Force, which includes Alex Burland, Fred Griffin, Jim Miller, Alan Pollack, Sally Rosenberg, Allan Tasman, Barbara Unger, and Jane Warren.
Societies and institutes affiliated with APsaA have a major investment in their psychotherapy training programs, which often graduate more practitioners than do the corresponding institute programs. Sally Rosenberg and Alan Pollack have established a workshop for directors of these programs that provides a national forum for discussion about teaching psychotherapy. More than a dozen local programs sent representatives to the meeting in January and we look forward to even greater participation at future meetings.
New psychoanalytic centers and study groups are finding that not only are such training programs an excellent way to introduce psychoanalysis to a community, but they also help build an active psychoanalytic center. The goal of the workshop is to provide an opportunity for participants to compare and study different approaches as well as to encourage innovation and experimentation in psychotherapy training. The Task Force will make a major effort to foster this workshop and to provide national recognition and support for local programs. We also would like to see more institutes offering courses in psychotherapy to their analytic candidates, as another way of closing the divide between the two forms of practice.
Do graduates of psychotherapy programs become a part of our psychoanalytic community or do they fade into the background? Qualified psychoanalytic psychotherapists need a home. Many of us feel APsaA would be the appropriate location for such a national base.
In recent years APsaA has established the Psychotherapist Associates, a category of non-voting membership that now numbers about 250 therapists. This group coordinates a program for psychotherapists at the national meetings and, in some areas, associates have established Associations for Psychoanalytic Thought (APT) Groups that function alongside the society or center. In other centers, especially newer ones, psychotherapists become direct members of the local society.
Former President Richard Fox is heading up a new initiative to promote psychotherapy within the organization and the profession.
Many graduates of the local programs do not join the Psychotherapist Associates. If the Task Force can promote associate membership, making it a more meaningful affiliation for psychotherapists, we will be able to recruit graduates actively to this membership category. We also will encourage the establishment of a membership status for therapists in all local societies and centers.
Psychoanalysts also contribute to psychotherapy by teaching and supervising (often without pay) students, trainees, and practitioners either in training programs, university departments, or privately with non-analyst colleagues. Only recently has APsaA recognized these contributions through the Edith Sabshin Awards for Excellence in the Teaching of Non-Candidate Students. Fifty analysts have received such awards in the past five years; very likely ten times that many analysts deserve such recognition. The Task Force plans to establish a workshop on psychotherapy supervision where supervisors can compare experiences and recognize the value of their role in mental health education. We hope this workshop will serve as a focal point for regaining our lost prominence in educational and training institutions.
Richard P. Fox, M .D., is immediate past president of APsaA, a past director of training at the Los Angeles Psychoanalytic Society and Institute, and currently a North American representative to the IPA Board of Representatives.
To enhance psychoanalysis in universities, however, we must develop research and scholarship in psychoanalytic psychotherapy. We are compiling a bibliography that highlights psychotherapy as a topic of study in its own right, not merely as a derivative of analysis. We are also working with the Program Committee to highlight psychotherapy in panels, clinical workshops and scientific paper sessions and are encouraging the submission of papers on psychotherapy to our journals.
Finally, as members of the psychoanalytic profession, we must ask ourselves some crucial questions: Is psychoanalytic psychotherapy a watered-down version of psychoanalysis or does it exist on a continuum with psychoanalysis? And is there another way to define psychoanalysis beyond the frequency of the sessions and the posture of the patient?