My Presidential Symposium lecture on “The Twilight of the Training Analysis System” at the recent 2013 APsaA National Meeting focused on two points: 1) the rigidities of psychoanalytic education and their contribution to the present crisis in psychoanalysis, and 2) a proposal for major innovation in the methodology and organization of our educational system. What follows is a summary of these points.
I believe there exists, nowadays, general agreement in our psychoanalytic community regarding major external challenges to psychoanalysis at this time: from neurobiology, psychopharmacology, and cognitive-behavioral psychology; critique of our lack of empirical research; restriction of all sources of funding for long-term, non-empirically validated treatments; and cultural biases regarding psychoanalysis, to name a few. As a consequence, we have fewer patients, fewer candidates, aging professional ranks, and loss of a foothold in university settings.
We also have significant internal problems, although there is less agreement about this: multiple theories without any methodology to assess their true value, professional isolation, and an uninspiring educational system. In earlier analyses, I suggested that while, in our institutes, we aspire to combine the models of a university college and an art academy, our institutes are closer to the combined model of a religious seminary and a professional technical school. A major cause of this development, I proposed, is the authoritarian structure of the training analysis (TA) system, derived from the non-functional appropriation by training analysts of all aspects of institutional life: analysis of candidates, supervision, seminar teaching, and administrative leadership. A non-functional accumulation of power determines the development of authoritarian social structures.
Major consequences of this authoritarian structure include the establishment of a social class structure, with the training analysts as the elitist echelon, the non-training analyst members in a second tier status, and the candidates at the bottom. Symptomatically, this structure fosters idealization, submissiveness, a paranoid atmosphere, splitting mechanisms, rebelliousness, and, above all, infantilization of candidates, dogmatism, fearfulness, and lack of scientific development and creativity. In addition, the authoritarian structure of psychoanalytic education fosters the corruption of power in psychoanalytic institutions, a fearful isolationism with disconnection from the surrounding scientific world, fearfulness over developing new applications of psychoanalytic thinking and derivative psychotherapeutic techniques to expand the realm of therapeutic effectiveness, and a persistent aversion to empirical research.
Dear Friends and Colleagues,
As I have written elsewhere, there has been a widespread misunderstanding of the PPP Proposal and the Fishkin Initiative as efforts to “democratize” our educational system. Nothing could be further from the truth. What is at issue here are fundamentally different views on how to achieve excellence in psychoanalytic education. Can it be best achieved in a self-perpetuating hierarchical system that operates entirely without oversight, responsible only to itself, and in complete disregard of our membership and our board of directors? Or can it be best achieved, as Kernberg suggests, by a “university model,” open to all elements of our Association, subject to debate, discussion, experimentation, and continuous orderly change?
Because of Kernberg's well-known writings on this subject, I invited him to give the Presidential Symposium in January. His presentation can only be described as a “smash hit,” with extremely enthusiastic responses from the audience. Because many people did not have the opportunity to hear Kernberg, I have asked him to summarize his comments, as my guest, in my usual presidential column. I think you will enjoy it and be stimulated to reconsider whether our current system of education is the most optimal one for a psychoanalytic association.
Historically the initiation of the training analysis system in the 1920s was functional and progressive. Its deterioration parallels the expansion of its power structure and the destructive development of a two-class social system, in which a large percentage of the graduated professionals are chronically condemned to be considered less than optimal practitioners. The criteria used to select training analysts are subjective and poorly defined. All decisions which affect the culture, curriculum, and progression of candidates are the purview of the training analyst elites: Would such a state of affairs be tolerated in any other professional specialty, say, in cardiology?
Otto F. Kernberg, M.D., is director of the Personality Disorders Institute, New York Presbyterian Hospital, Westchester Division; professor of psychiatry, Weill Medical College of Cornell University; and training and supervision analyst, Columbia University Center for Psychoanalytic Training and Research.
The negative reaction of the international psychoanalytic community to this institutional situation has been growing. In France, in Germany, and several Latin American countries conflicts have arisen between the membership of psychoanalytic societies and psychoanalytic institutes' leadership. In the United States, at this time, an institutional conflict between the Executive Council of APsaA and the Board on Professional Standards (BOPS) reflects these dynamics. Understandably, from their position, BOPS has refused, so far, to accede to the Executive Council's demands for objective, reliable, and transparent criteria to be established for the appointment of TAs. An enormous amount of time, energy, and resources is funneled into the conflict between internal administrative bodies of psychoanalysis, while serious external challenges confront psychoanalysis with its scientific, academic, and cultural environment.
As one solution to our internal problems, I propose a fundamental reorganization of the educational system of psychoanalysis. What follows are concrete recommendations that apply to APsaA, but the general principles involved should apply to the International Psychoanalytical Association (IPA) as well. In fact, much of the evidence that I presented in my Presidential Symposium lecture reflects my experiences as a former president of the IPA.
I propose that we abolish completely the training analysis system. The designation of training analysis should be replaced by an objective, reliable, and transparent set of criteria of professional competence, assessed in a certification process with these same characteristics, open to all graduates of all psychoanalytic institutes within a certain number of years after graduation that provides them with additional clinical experience. This certification would be equivalent to board certifications in medical specialties, and be carried out by an external certifying board established by the national organization, in this case, APsaA with a rotating membership nominated by the membership at large and elected by the Executive Council. This certifying board, which also could serve as a committee for the accreditation of institutes, would function completely autonomously and carry out the certification process on the basis of established standards of competence corresponding to the educational objectives specified by APsaA, to which I shall return. All certified analysts could analyze candidates, and the personal analysis would be carried out completely independently of all the psychoanalytic institutions' educational functions.
The present Board on Professional Standards would be abolished, and replaced by an Education Committee with a number of highly expert, nationally and internationally recognized educational experts, nominated by the membership and elected by Executive Council. This Education Committee would carry out the task of defining the criteria of professional competence and the major objectives of psychoanalytic education, developing the methodology for achieving these objectives, and defining the criteria for assessing, step by step, the achievement of corresponding competency by psychoanalytic candidates. A Conference of Institute Directors would generate information and proposals to the Education Committee, and, eventually the Education Committee's major mission would become the ongoing effort to improve the methodology of psychoanalytic education.
In my lecture, I referred to tentative criteria for the evaluation of competence that are already available, namely, psychoanalytic knowledge, technical skills, and analytic attitude. I described organizational arrangements that would assure the autonomy of the Certifying Board, the Education Committee's ongoing efforts at renovation, and the ultimate responsibility of the democratically elected Executive Council to assure the effectiveness of these structures involved in psychoanalytic education. Finally, I stressed that the simple abolishment of the training analysis system and of the Board on Professional Standards would not solve by itself the problems of rigidity, the authoritarian structure, and the lack of present day educational objectives, methodology, and functional methods of certification and of accreditation of institutes. Much preliminary work by the proposed Education Committee will become necessary before the other aspects of the proposed new structure are put in place. I trust that this work will end the present stagnation of psychoanalytic education, facilitate a dynamic energizing of the functions of psychoanalytic institutes, and, by providing appropriate, functional criteria of professional competence raise the institutional commitment of APsaA to an engaged and stimulating relationship with our surrounding scientific, professional, academic, and cultural environment.