The Committee on Institutes (COI) visits four institutes each year and, as most of you know, these site visits extend over four days and produce extremely detailed reviews of an institute's educational functioning. Over time the accumulated knowledge arising from these visits gives the committee a broad and deep view of analytic education across the country. This makes us aware of the many challenges facing analytic educators as well as the responses they have made to them. In addition to our own observations about teaching at institutes, we have had the help of Paul Holinger and the Certification Examination Committee (CEC). They have identified difficulties colleagues have in presenting their work, which most often do not represent personal limitations but limitations in analytic education. Holinger's committee, for instance, noted the difficulty many colleagues have in making themselves clear in writing and, at times, speaking about their work.
The ability to clearly describe one's work and one's thinking to others is an important professional achievement.
They noted problems formulating cases and describing termination phases, this latter related to candidates' often graduating without a terminated case.
The Committee on Institutes recommends that institutes incorporate the following framework for teaching clinical thinking into their curricula. We propose a sequence of courses which include 1) seminars on analytic writing, 2) seminars on formal oral presentations of clinical material to classmates and faculty, and 3) greater attention to the termination phase of analysis. The courses on writing and formal presentations would begin early in and continue throughout training. They would supplement the usual courses on psychoanalytic theory and technique. The purpose of the courses and presentations is to enhance candidates' ability to assess psychopathology, formulate cases, and describe the dynamic currents in sessions over longer periods of the treatment and ultimately through the arc of an entire analysis. Writing courses, pioneered by Stephen Bernstein, have proliferated throughout the country. These courses focus on the articulation and communication of analytic ways of understanding. COI, through our site visits and committee discussions, hopes to collect models for teaching writing that seem to us to have been most effective and to disseminate them to interested institutes.
The ability to clearly describe one's work and one's thinking to others is an important professional achievement. Formal oral presentation of a candidate's work should be part of every curriculum. Early in training the focus might be on initial assessments and brief clinical vignettes. Later longer portions of an analysis might be described and at advanced stages of training a complete or nearly complete analysis. Institutes have developed a variety of approaches to the presentations of clinical material. The Houston-Galveston Psychoanalytic Institute has a system in which analysts unfamiliar with a case, i.e., someone other than the supervisor, read and discuss annual summaries with the candidate. A number of institutes, Chicago and Los Angeles included, require lengthy case reports which are presented to and discussed by the candidate with a panel of analysts. At some institutes such presentations occur in the middle of training and determine whether candidates advance to the final stage of their candidacy At other institutes they occur later as a determination of readiness to graduate. Again, useful models of education that encourage formal presentation can be collected and disseminated.
The teaching about the termination phase of analysis, in some institutes, may not be given as much attention as is needed. Candidates have often completed their own analyses and may have even graduated before they terminate an analytic case. This makes it harder to organize a course of study in termination at a time most relevant to the candidate. Asking graduates and advanced candidates to formally present material from their work on termination may be one way of addressing this issue. A series of scientific meetings that focus on the subject may be another: We would hope that directors of institutes coming together at the COI sponsored Meeting of Directors might address this educational issue in greater depth
By regularly writing and speaking about their work, including termination of analyses, candidates will enhance their developing capacity for self-observation and self-reflection. Gradually this will prepare them to function independently with the assumption that after graduation they will continue these processes of reflection on their own and in supervisory dialogues with individual analysts and groups of colleagues. This will enable them to write about and describe their work in professional settings as authors of journal articles or as teachers of psychoanalysis. It will also prepare them for the clinical reviews of their work required for career advancements by whatever certification and training analyst appointment procedures are in place.
Editor's Note: This article replaces the BOPS column, which will return in the next issue.
Elizabeth A. Brett, Ph.D., is training and supervising analyst at Western New England Institute for Psychoanalysis and associate clinical professor of psychiatry (psychology), Yale University School of Medicine.
Daniel H. Jacobs, M.D., is a training and supervising analyst at the Boston Psychoanalytic Institute and director of the Center for Advanced Psychoanalytic Studies.