In our mobile society, psychoanalysts are not exempt from the pressures to relocate experienced by those in other professions—new job offers, spouses changing their workplace, new marriages, aging parents. In fact, records from the National Office of the American Psychoanalytic Association indicate that 179 analyst-members have moved to different states within the last three years.
What is unique for psychoanalysts is the intimate bond they share with their patients, the commitment that they have made to maintaining the analytic frame, and their concern for those they are leaving, who may be quite vulnerable to dramatic changes in their treatment. Those analysts who have moved often describe a wrenching leave-taking as well as technical difficulties with the forced terminations. Relocating to a new area can also present obstacles, such as a struggle with different theoretical orientations or practices in the new institute setting or with finding colleagues for psychopharmacologic consultation or vacation coverage.
Several psychoanalysts who have moved their practices, for different reasons and at different stages in their careers, were interviewed for this article. Some were training analysts moving for professional or personal reasons, others were new graduates or certified analysts. Some requested not to be identified in order to allow for a freer expression of their views. Two areas of concern emerged from the interviews: managing the forced terminations and forging an identity within the new practice area.
Every psychoanalyst interviewed said they had sought consultation about the patients they were terminating. Some sought help from peer supervision groups in which they were already comfortable, others spoke with analysts who had experienced such a process themselves. “We are all masters of self-deception, and seeking consultation at such a time is essential,” noted Glen Gabbard, who moved from Topeka to Houston several years ago and recommends consulting with someone who has handled such a move.
One focus of the consultations concerned managing the analyst's own grief about leaving patients, as “the analytic relationship is a real relationship with another human being to whom we feel committed…. An analyst inevitably struggles with guilt feelings about putting one's own priorities above their needs,” Gabbard said.
Marie Rudden, M.D., is training and supervising analyst at the Berkshire Psychoanalytic Institute, on the faculty of the New York Psychoanalytic Institute, and a clinical assistant professor of psychiatry at Weill Medical College of Cornell University. She recently relocated her practice from Manhattan to the Berkshires.
Concurring with Gabbard, Jerry Fogel, who moved from New York to Portland, Oregon, also mentioned needing to hold a “tragic view of life in which you realize that you cannot control everything, even though you might wish to.”
Many consultants helped with practical advice in addition to management of countertransference feelings. Cecile Bassen, who relocated from Washington, D.C. to Seattle, found that speaking with a consultant before she notified her patients was helpful in alerting her to the option of continuing well established treatments by phone, rather than terminating with all of her patients. With this in mind, she was better able to explore patients' wishes and fantasies about treatment options. These included requests to continue by phone, challenging assumptions that this was out of the question, and requests for referrals in tension with assumptions that the individual would or should stop treatment. Subsequently, she used consultants to heighten her awareness of transference and countertransference reactions.
Moving “makes analysts aware of how embedded they have been in a given psychoanalytic culture….Even if the new setting is receptive and open, one still needs to make a significant adjustment. And no matter how confident you are as a practitioner, an almost invisible support system becomes lost to you.”
Jerry Fogel emphasized this point: “One cannot underestimate the impact of the analyst's leaving. It is important to take full responsibility for the decision, to not minimize its impact, and to work with a consultant closely about the attendant countertransference reactions.” Fogel cautioned about countertransference feelings—a need to hang on, grandiosity, or guilt about leaving—that might prompt adopting phone work as a long-term solution, but did feel that in some circumstances, phone treatment, carefully thought through with an experienced consultant, might be a valuable treatment option.
One analyst who continued a training analysis by telephone supplemented by in-person visits noted that important new material emerged in this setting. The individual's analysis deepened because of his profound feelings about being abandoned, and about the analyst's response to his strong wish to continue. He was also freed from inhibitions associated with working in the same community as the training analyst.
Other analysts expressed concern, however, about losing data in the middle phase of an analysis, and advocated telephone contact largely for certain psychotherapy patients or analytic patients already in the termination phase.
Every analyst interviewed voiced concerns about the period of time available to terminate. At least six months for analytic patients seemed to be optimal. Although Lisa Korman, for whom this had not been possible when she moved from New York to Chicago, found her consultant's comments quite helpful:“One more month with this patient will neither assuage your guilt nor solve all his problems.”
Glen Gabbard observed that moving “makes analysts aware of how embedded they have been in a given psychoanalytic culture….Even if the new setting is receptive and open, one still needs to make a significant adjustment. And no matter how confident you are as a practitioner,” he observed, “an almost invisible support system becomes lost to you.” Several analysts mentioned a painful loss of their analytic communities and said it took three or four years to fully integrate themselves into a new professional community.
Most analysts advocated speaking extensively to people who have knowledge of the new professional community before considering relocation, noting, “It will matter that people understand who you are and try to welcome and support you.” Fogel has concluded that institutes that are trying to attract new analysts should be made aware of “the need for welcoming and caretaking” of the new recruits. Others found it important to anticipate the kinds of competitive issues, mutual projections, and “cognitive dissonance” that might arise between the new and established analysts.
Gabbard offered hopeful counsel for those relocating: “Moving an analytic practice is survivable, not a catastrophe. It can even be a renewing experience when one feels invigorated by a new setting.” One dimension of this re-invigoration others cited was the opportunity to learn about different ways of thinking—about theory and practice, and about different approaches to institute structure.