At the January 2012 APsaA National Meeting at the Waldorf Astoria, the Board on Professional Standards voted unanimously to extend an invitation to the William Alanson White Institute (WAWI) to become an approved institute of the American Psychoanalytic Association. This is a historic decision for APsaA and one that has the overwhelming support of the members of the Committee on Free Standing Institutes (CAFI), the Coordinating Committee, and the Executive Council. As we await the response from WAWI, it might be helpful for our members to know how we got here, what it would mean for our organization, and what it could mean for the profession of psychoanalysis.
For more than 10 years, CAFI, a committee of BOPS, has met at least yearly with representatives of WAWI at our national meeting to explore the possibility of a formal affiliation between the two organizations. During that time, there have been representatives from WAWI serving as non-voting members on both the Board on Professional Standards and the Executive Council of APsaA; members of our Association have been invited speakers at WAWI and many of their analysts have been featured speakers and presenters in our educational programs.
In 2008, a Task Force on Training Models (TFTM), made up of members of WAWI and members of APsaA was created to study the similarities and differences of the education and training in psychoanalysis. The TFTM made its report to BOPS in January 2009. The TFTM concluded, and BOPS has agreed, that WAWI, though different in some significant ways, is an equivalent model of psychoanalytic education and training, a variation of the Eitington model. Most importantly, through these shared experiences the participating analysts have developed collegial relationships based on mutual respect and a deep commitment to psychoanalysis.
We are aware that while many of our members are excited about the opportunity that this invitation holds, others are puzzled: How could WAWI become an approved institute of APsaA when they have training standards that are different from our own? It is important to clarify that some of their standards differ from ours but others are strikingly similar and even identical to APsaA's. For example, the admission criteria, the requirement of a training analysis, experience with at least three different supervisors as well as experience with analysands of both genders are all identical requirements in both APsaA and WAWI. However, the training models do differ in some significant ways.
There is no question that the most controversial and confusing difference between these two training models has to do with required frequency of analytic sessions and the use of the couch.
APsaA's didactic curriculum involves roughly 450 hours of class time, spread over four to five years, while WAWI's curriculum includes 540 hours of class time distributed over four to six years. WAWI requires at least four supervised cases while APsaA requires three cases. While they both require a training analysis which is concurrent with the course work and supervised clinical work, APsaA's TAs are required to be certified in psychoanalysis, having been immersed for 3600 hours with four non-psychotic cases for five years post graduation. WAWI training analysts are appointed after a minimum of seven years post graduation, and go through an internal vetting process comparable to our combined certification and training analyst evaluation process, not unlike our new developmental pathway process to certification/TA appointment.
In APsaA, supervising analysts have historically been appointed using the same criteria and process as the TA appointment. However, in our new standards we have separated these functions and are beginning to think about and develop specific criteria for supervising analysts that take into account the central educative and synthesizing role of the supervising analyst. At WAWI, analysts are qualified to be appointed as supervising analysts five years post graduation and through a separate interview/examination process.
There is no question that the most controversial and confusing difference between these two training models has to do with required frequency of analytic sessions and the use of the couch. It is probably well known that the WAWI model requires their candidates, as well as the control cases that they see, to be in analysis a minimum of three to five times per week; these analyses are conducted with the patient on the couch or face-to-face, contingent on diagnostic impressions, treatment strategy, and the clinical judgment of the SA and the candidate.
WAWI also permits the inclusion of borderline and psychotic cases as training cases.
Colleen L. Carney, Ph.D., is chair of the Board on Professional Standards, and
Beth Seelig, M.D., is secretary of APsaA, a member of CAFI, and was co-chair of the TFTM.
APsaA has been interested in the treatment of so-called widening scope patients for over 50 years, but our training programs have not been particularly geared toward the treatment of these patients. Yet, we know that many of the cases our candidates treat are probably in this diagnostic category. In this regard, the focus of the WAWI model more clearly acknowledges that some of our control cases may not be amenable to the same technique of psychoanalytic treatment that is usually the treatment of choice for most neurotically organized patients. What kind of treatment is advisable for these patients? Are we training our candidates to recognize the full spectrum of psychopathology and to thoughtfully decide on the best treatment based on the needs of the patient? Having this focus included as a part of psychoanalytic training is truly one of the great strengths of WAWI. In addition, their training model includes supervised psychotherapy as a required part of their training program. These are differences we hope to study, become familiar with, and learn from.
Some individuals might ask if this means that our own institutes will be free to let our candidates see control cases at a frequency of three times a week. To equate the differences between the APsaA and WAWI models only with the difference of minimum frequency misses the essence of their training philosophy, as we understand it. BOPS voted to make it official policy of the Association that any institute approved by the American Psychoanalytic Association wishing to adopt the WAWI variation in its entirety would be permitted to do so. This change, which would require a change in our standards, would be subject to the oversight of BOPS, with members from WAWI providing the leadership for such oversight, should they accept our invitation.
Finally, we would like to conclude with a broader reflection on the potential impact of this prospective historic union for the profession of psychoanalysis. At a time when mental health treatment in general has become fragmented, simplified, and at times dehumanized, a partnership of two organizations that have been leaders in the training and practice of psychoanalysis would provide a meaningful unified front. We hope that the White Institute's internal discourse in response to our invitation will reflect the same optimistic anticipation that such a proposed partnership will open many doors for collaborative research, increased public visibility, and ongoing dialogue, paving the way for the future for psychoanalysis.