While passionate and cogent arguments have been made by both sides of the debate on certification, standards, and the training analyst system and designation, such debate has served to distract us from what I believe is the critical issue confronting psychoanalytic educators today.
I will say upfront that I am in favor of some type of certification process or test and its link to the training analyst system of selection and evaluation. I support each conceptually, but both need improvement and both should be nationalized so that TAs need only go through such an evaluation once in their professional careers, no matter where they choose to roam geographically. What I propose here, however, has nothing to do with this debate or my position about it. Rather, my proposal concerns the problematic, deeper clinical issues regarding candidates that are embedded in our current model of psychoanalytic education, from which the debate on certification and the TA system has been a distraction.
In May I attended a faculty meeting of the New York University (NYU) Psychoanalytic Institute. At the top of the agenda was the Project for Innovation in Psychoanalytic Education (PIPE) report. As would be expected, differing points of view on certification, on whether it should be linked to the TA process and selection, on whether there should be either or both, were represented. A senior analyst declared, with much heartfelt emotion, that he felt that forcing candidates into treatment with training analysts led to a “bad family” situation wherein candidates and their training analysts were both in a fish bowl, each feeling observed and evaluated. This, he added as a matter of fact, does not lend itself to a truly therapeutic experience for the candidate. I asked him how it would be different for our candidates if they were permitted to see non-training analysts of the institute? Wouldn't the fish bowl problem still exist? Wouldn't the issue of the candidate never being able to “break free” of his or her analyst, training in the same institute, persist whether the analyst was a training analyst or not?
Being in treatment with an analyst at an institute different from the one at which the candidate is training is not only therapeutically sound, it is best for the candidate's professional development and, ultimately, for the survival and creativity of the institutes and the profession of psychoanalysis.
As one of three institutes accredited by the American Psychoanalytic Association in New York City, the NYU Psychoanalytic Institute is fortunate to have two other institutes from which candidates can choose a training analyst. Not only is this a tremendous advantage to the recruitment efforts of these institutes, it permits the candidate a wider selection of “acceptable” analysts from whom they will not have to be torn should they decide to train at an institute other than the one in which the candidate's analyst is involved. It is also, most importantly, of tremendous therapeutic value to all potential candidates. Long before the shortage of applicants facing many of our institutes today, I had argued for allowing applicants to remain in treatment with a TA from either of these two institutes. It did not make clinical or therapeutic sense to force someone out of a viable treatment simply to be in treatment with “one of our own.” It could well be deleterious to the applicant/future candidate, while it simultaneously sets the stage for what I will call tribalism among competing institutes. Once the change was formally accepted by the three institutes, I informed the Education Committee that I would not be accepting referrals of candidates from our institute. I can think of no clinical argument against this position. Being in treatment with an analyst at an institute different from the one at which the candidate is training is not only therapeutically sound, it is best for the candidate's professional development and, ultimately, for the survival and creativity of the institutes and the profession of psychoanalysis. The “inbreeding” that has gone on for generations, and continues in our institutes today, was a necessary but unfortunate byproduct of the fact that so many institutes in the country did not have other APsaA institutes in their areas at which candidates could seek training analysts for treatment. However, this inbreeding has been the worm eating at the core of the apple of the institutes of the Association. And there is a solution.
Throughout the course of evolution, inbreeding ultimately and without fail destroys the culture or the species to which it is victim. Recycling the same “gene pool” of an institute follows the laws of evolution: It leads to a weakening of the successive generations, a deadening of creativity, and the increasing loss of the possibility of giving rise to truly remarkable individuals with novel ideas and the freedom to express them. To spend one's entire
Sylvia S. Welsh, Ph.D., is a clinical associate professor of psychiatry at NYU Langone Medical Center. She trained at NYU Psychoanalytic Institute and has a private practice in New York.
professional life at one's own institute while continually faced with one's analyst is the antithesis of promoting independence of thought and individuality. We all know that transference is never fully resolved; it takes more than should be required of us, if one is so inclined, to take an opposing position to one's analyst, particularly if that analyst holds a position of power in the institute.
In line with the ideas of tribalism and inbreeding, analytic training has traditionally rewarded conformist behavior in candidates while it subtly, and not so subtly, punishes those who challenge the status quo. This is made all the worse when the candidate's professional development is being “watched” by his or her former analyst (even if this is only the fantasy of the analysand/candidate). The institutes of the Association have, sadly, become analyst-oriented when they should be candidate/patient-oriented. In a candidate-oriented institute, what is best for the candidates/patients would be first and foremost in the minds of those of us who are entrusted with their treatment and education. Thus, turf, status, and economics, often rationalized by the need to know that the analysis the candidate is receiving is the “right” kind of analysis (i.e., “administered by one of our own”) would be subsumed under the imperative to ensure that the candidate had the best chance of entering an analysis of true therapeutic value with an analyst of his or her choice; an analysis as much separated from the sense of being evaluated as possible and as much separated from the commonly held idea by candidates that their treatment is simply part of the educational model of the institute and, thus, must be conducted in a specified manner, perhaps without regard for the particular and unique needs of the individual candidate.
The institutes of the Association have, sadly, become analyst-oriented when they should be candidate/patient-oriented.
As I listened to the arguments for and against the TA and certification systems, it dawned on me that the entire tripartite model, the holiest of grails in analytic training in the institutes of the Association, is deeply flawed and simply does not work if what we are after is both educating analysts and encouraging candidates to experience analyses that are real. If looked at in this way, the institutes should have nothing do with the candidate's choice of analyst. Even more radically, the institute should simply require that the candidate be in analysis and leave it to the “honor system” that candidates will enter and complete an analysis. We can and should judge the education of our candidates, their progression toward being analysts, by the work they do with their patients (supervisory reports) and their class participation (reports by instructors). As it stands now, we have no way of knowing what, if anything, the candidate is actually getting out of the analysis we often “force” them to be in. Time and again, we have heard colleagues say that they did one analysis “for the institute” and one for themselves.
This is a sad and sorry state of affairs to which we, as educators and psychoanalysts, have been complicit. It need not be this way. We must strengthen our educational standards so that we may rely on our institutes to graduate only those candidates who demonstrate their grasp of the analytic process and theory and their competence in conducting an analysis. Nothing else is our business, including judging the type of analysis a candidate chooses, or with whom they choose to be in treatment—only that they be in analysis. Our institutes, in order to survive and to do what is right for our candidates, should require that the candidate be in analysis but should have nothing whatsoever to do with it after that requirement is made clear. We need know nothing more about it. We must trust our ability to judge the quality of our candidates' work based on the reports of their supervisors and their instructors, as we already do for all intents and purposes. We can openly and safely do away with the tripartite model of education and, rather, focus on a “bipartite” model: supervision of the candidate's work and academic instruction through which we can assess the candidate's clinical competence and understanding of analytic processes and theory.
The adoption of the bipartite model of education does not negate the value of standards of certification and training analyst. In fact, candidates may, indeed, seek out those analysts who have been certified and/or who are TAs. Or they may choose to be in treatment with someone from outside our ranks. That should be accepted without fear if we rely on our educational standards. Opening our doors, our minds, and our gene pool may prove to be what saves our profession as it quite literally breathes new life into our institutes.
Psychoanalysis is founded on a history of encouraging and valuing independence of thought. Independence of thought without fear of expression is the very heart of creativity. Expanding the gene pool increases our possibility of surviving and thriving, while it underscores our deepest and most profound responsibility: to educate analysts so that they may provide their patients with the treatment that is therapeutic and fluid enough to meet their patients' needs. In order to ensure that our candidates become therapeutic psychoanalysts, we must help them to have conviction in the healing power of psychoanalysis through their own treatments. We have not done so to the extent that we should have for many practical, ideological, and not-so-lofty reasons. I refer here, again, to issues of turf, status, and money. When an analyst relies on the treatment of candidates (or any patient) for prestige, power, or finances, this patient simply cannot be treated in the manner that is most therapeutic. The bipartite model of psychoanalytic education conveys the message that the candidates, not the analysts, are what are most important. The candidates will, in turn, reward the institutes and the field of psychoanalysis. Most importantly they will know how to heal the patients they will ultimately serve.