Psychoanalytic education and training have engendered a number of lively and interesting dialogues in recent years. Probably the most well known has arisen repeatedly since the earliest years of organized training programs. It concerns who should be accepted as candidates for psychoanalytic training, and what requirements are appropriate. This has been mistermed the “question of lay analysis.” Initially it divided the profession and challenged Freud's leadership; later it threatened the very existence of the American Psychoanalytic Association. Is psychoanalysis a branch of psychiatry, a subspecialty of the mental health professions, or a new perspective on the human mind far too precious to be relegated to the control of medicine and the health professions, thereby excluding the rich and imaginative contributions of scholars from the humanities and social sciences along with those of other empathic and creative individuals who come from a number of pathways? The question has been, and is, answered in a number of different ways by different groups in different settings, most often not by addressing the underlying issues, which I shall address momentarily, but rather as part of a solution to immediate problems of the supply of candidates, of the attitudes of the professions and society, and most of all of guild concerns of the profession.
Other dialogues concerning training and education have considered re-evaluation of the training analyst system, 80 years after its birth. Should training analyses be considered an educational issue; should there be designated training analysts, and if so designated by whom and based on what criteria; should the training analysis be replaced by a personal analysis, what is the difference, and perhaps most specific and most contentious, what if an appropriate applicant for training is in analysis with an analyst who is not a training analyst?
There have also been discussions about curriculum. Should theory be taught historically or conceptually? Should theoretical pluralism be emphasized or marginalized? Should technique be taught as derived from theory, or theory as a tool employed in technique? Should analytic curricula include discussion of psychopathology, psychotherapy, or alternative treatments? What is the relevance of developmental psychology, neurosciences, language and narratology, research, methodology of treatment evaluation, or applied psychoanalysis to the psychoanalytic curriculum?
Supervision is generally viewed as more important than the didactic curriculum and easier to discuss than the training analysis. There have been discussions of the appropriate focus of supervision—the patient, the supervisee, the therapeutic process or the supervisory process, the relation between teaching and evaluation, the boundary between treatment and supervision, and, related, the question of the reporting vs. non-reporting supervisors.
There has been interest in the relationship between education and evaluation, and particularly professional certification—its reliability, validity, impact on the profession, and impact on the public. Reasonable people have widely discrepant views: that certification is impossible, that it is essential to maintain professional standards, that it is essential to protect the public, that it is irrelevant to the essence of what psychoanalysis is, and that it is desirable if done appropriately, but that it is not yet feasible to do it appropriately.
These are all important and interesting topics. For the most part they can be traced back to the 1920s and the development of the first systematic program of professional training at the Berlin Institute, followed by tensions between the Berlin and Vienna institutes, tensions that were then exported to the New World, along with the Berlin and Viennese analysts, and where they have continued to the present. I believe that there are important underlying questions that are not often articulated (in contrast to the derivative questions outlined above, which, to my taste, are too often discussed!).
One fundamental underlying question is the basic goal of the process. Is it to train practitioners so that they can conduct psychoanalytic treatment in the community or is it to educate professionals to assure the continued growth and progress of psychoanalytic knowledge? If it is training, a primary concern is to assure the public of the quality of the graduates. They should be ethical, safe, and effective. It is very important not to graduate anyone who fails to meet these standards, even at the risk of burdening or even excluding some who may meet them but about whom, for one reason or another, it is difficult to be certain. More attention will be devoted to ensuring that the worst practitioner is not too bad, even at the cost of limiting the potential excellence of the best. Professional socialization is as important as professional training—practitioners must accept the importance of peer standards and peer review, and recognize that revolutionary procedures or ideas are to be reviewed and approved by colleagues before the public is exposed to them.
Robert Michels, M.D., is Walsh McDermott University Professor of Medicine and Psychiatry at Cornell University. He is training and supervising analyst at the Columbia University Center for Psychoanalytic Training and Research.
Education is a quite different goal. It demands that we attract the brightest and the best, making certain that no one is screened out because he or she is too creative, maverick, innovative, or challenging, with less concern that someone of questionable merit might slip through as a result. The central quality concern is not that the worst not be too bad, but that the best have no barrier to being as good as possible. The culture of learning should encourage skepticism, freedom of thought, and tolerance of diversity rather than conformity and adherence to group norms. The boundaries of discourse, and of the community itself, are permeable, with the views of members of related disciplines or other creative and intelligent individuals welcomed and seen as having potential value.
The culture of learning should encourage skepticism, freedom of thought, and tolerance of diversity rather than conformity and adherence to group norms.
While these two views of psychoanalytic training and education are not contradictory, they are in potential conflict. The optimal resolution of such conflicts varies with the developmental stage of the discipline, the cultural setting, and the individuals and institutions involved. It requires dialogue, and dialogue requires trust and respect. However, the actual resolution of many such conflicts reflects political concerns, self-interests of the participants, and the association of specific positions with admired or disliked psychoanalytic theories and theorists.
Problems of this type go back to the early history of psychoanalytic education. The early debate concerning “lay analysis” was heated, acrimonious, and conducted with little trust and respect. As a result the discipline paid a heavy price. The current debates concerning the appointment of training analysts, the inclusion of psychotherapy in the curriculum and certification have some of the same quality. One issue underlying each of them is the professional concern to assure the community regarding the quality of practice in contrast to the academic concern to provide optimal conditions for the advance of knowledge. Perhaps, in our second century, we can extricate ourselves from political entanglements and personal interests enough to discuss the appropriate balance between these fundamental but at times competing goals, and to achieve what Freud was never really able to accomplish—a profession that recognized the importance of reliable practitioners, advancing knowledge, a system of education and training that facilitated both, and a community of analysts that recognized and accepted both goals along with the inevitable tension between them.