When I was still a candidate in 1995 doing both adult and child training programs at once, I remember asking naïvely why I couldn't graduate from the child program first, assuming I had met the requirements. My supervisor answered knowingly that that would not happen in my practice lifetime, though there was some talk at the national level about these very issues. He assured me that I would appreciate my training more if I waited until I terminated an adult case. He said adult termination is a unique experience and I would be glad I had waited. I had no choice but to believe him, put my child diploma on ice for two more years, and graduate from the adult training program. When that time finally came, I discovered the termination experience of the child case was in fact the more exciting and valuable experience of the two. I was angry, but angry candidates were nothing new.
About this time our institute in Houston opened the doors of our beautiful new therapeutic school, now called the Harris School, which started in 1989 as an outreach program to preschools. The school developed into a center for referrals of problematic children, and education for teachers and parents. Recently it expanded even more, in response to community need, to include emotionally troubled middle school age children. In order to train the numbers of parent and teacher helpers that were needed to run the school, Art Farley and Diane Manning, the two very capable directors of the school, began a pilot two-year child psychotherapy fellowship program at our institute, patterned after our successful experience with an adult psychotherapy fellowship program.
Our advanced child analytic candidates mostly taught the child psychotherapy fellows, as candidates were given the choice to teach in lieu of attending child continuing case conference. After the first group of fellows graduated from the two-year program, many of them wanted to continue their analytic education, but we found we had no suitable program to offer them. Some fellows did not meet the degree requirements to apply for candidacy, some were working primarily with children and could not see the relevance of adult training, and some had already done the adult fellowship and felt that was enough.
Until the spring meeting of APsaA in 2001, we were left with no program to offer these graduated fellows. A window of opportunity opened up when the Committee on Child and Adolescent Analysis (COCAA) solicited proposals to look at pilot programs in independent child analytic training. We were designated to be one of the four sites, one of two that would require an adult case in addition to the three child cases. For that reason, we do not call ourselves a “child-only” program, but a “child-focused” program.
The requirement of one adult case has perhaps generated the most controversial aspect of the program at our institute for several reasons. The child-focused candidates, in order to be able to analyze their adults, were asked to attend one course each trimester for three years with the adult class. (The full adult candidates take three courses each trimester for four years.) At least one course per year should be the adult continuing case, at least one should be a technique course, and one should be analytic theory. They were excused from child development courses, as these were well enough covered in the child section of their training, but adult development courses were included.
Penelope Hooks, M.D., is incoming president at the Houston-Galveston Psychoanalytic Institute, where she is chair of child analysis; training and supervising analyst; and supervising child and adolescent analyst.
The curriculum committee of the institute expressed concerns about how the child-focused candidates would affect the group dynamics of the adult classes, both because of differences in perspective and because they would not be present for all classes. Another concern was that after analyzing one adult, the child graduates might present themselves to the community as adult analysts. We explained that in the way that surgeons might do a rotation on internal medicine for purposes of a well-rounded education, or that universities offer courses to students who are not majors in the field, we are trying to cross-fertilize sections of our institute for the enrichment of both. At this time it remains to be seen whether we will keep the requirement of one adult case, as it may turn out to be easier to do away with it. Personally, I hope we keep it in, because although child analysts become perhaps more tolerant of affect and action than their adult analyst colleagues, they still need to develop respect for the value of abstinence.
In addition, these candidates in the child-focused program are required to have a training analysis. They are also required to do the equivalent of a one-year internship at the Harris School, which involves observation of children in the classroom, attendance at one staffing meeting per week, and giving one or more hours per week of parent helper work. The child analytic case requirements are the same as the familiar ones for other child candidates—three cases, each gender, one to termination, one latency and another adolescent, and a graduation colloquium.
In the first year of our new pilot program, we began with two child-focused students. We carefully monitored how well they performed in their classes as judged by their instructors. We found no significant difference between them and their classmates. After two years, both child-focused students are doing well, and one has decided to become a full adult candidate. We will begin our second child-focused program this year, and again we have two applicants.