The COPE study group on the role of developmental curriculum in clinical teaching, Teaching Development to Adult Candidates, arose out of a debate among psychoanalytic educators about the value of developmental knowledge for psychoanalytic theory and practice. The proponents are certain it is central; the opponents say it has little or no value. The study group aims to take up this debate in order to clarify the role of developmental curriculum in psychoanalytic education.
Our study group, which met face to face for the first time in January 2013, has progressed through a series of projects. The first project was organized through phone and e-mail contacts prior to meeting in person. We surveyed institutes' curricula and assessed the range of developmental educations they offer. Differences among institutes were considerable. At one extreme were those that require four years of development courses, alternating adult and child process and infant or normal child observation, and at the other extreme, a few that have only a single year-long development course and a single eight- week exposure to adolescent process.
The survey led to the question: How are we to assess the impact of this range of curricula on candidates' knowledge of theory and practice? We planned two approaches to the question that we could pursue at the January 2013 APsaA meeting: 1) a day-long meeting with two case presentations given by senior candidates or recent graduates to a larger candidate group in which these differences in immersion were represented; 2) a review of case write-ups utilizing an objective measure to assess the use of developmental concepts.
In regard to the first approach: The conference produced very rich and lively conversations among the candidates, as they discussed the two adult cases currently in analysis. Due to constraints of time and available study group members, we could not conduct individual interviews with the candidates in order to assess individuals' reliance on developmental thinking and how much it shaped their observations. In the context of a group discussion, there were clearly differences in candidates' developmental thinking, but they were not directly correlated with their formal educations and in fact seemed entirely independent of where they trained. Moreover, it was difficult to clarify whether we were observing differences in theoretical orientation, personal or professional experience, supervisory input, skill, analytic talent, or something specific to developmental education.
In regard to the second approach: This aspect of our research involved looking at the candidates' description of their own clinical material, a method we hoped would offer better access to their comprehensive approach to patients and thereby clarify the role that developmental concepts played in their thinking. One group member, Jeanine Vivona, did a masterful job of developing a rubric for assessing written case reports and applying it to case write-ups elicited from our participants. The candidates were asked to choose a single example among their existing case write-ups, one that they felt represented their best work. Based on preliminary findings, this approach seems to hold more promise in regard to differentiating individual candidates' clinical thinking.
We are considering a number of approaches to this material, including correlating the candidates' rubric scores with formal development education and further individual interviews to trace the origins of their developmental knowledge, bearing in mind the possibility (referred to below) that such origins may be as elusive as the origins of individual psychology and neurosis. [Editor's note: For a copy of the rubric, please contact Jeanine Vivona at .]
Conversations among the active participants in the study group have raised a number of interesting and complex issues. A fundamental and persistent question we have is whether the study group's mandate is framed correctly. Given our observation that developmental awareness and knowledge seem to arise from many sources, is it of value to assess whether the formal curriculum accounts for a lot or a little? Is it useful or possible to know where a given person's developmental knowledge comes from? Is it an intrinsic component of good clinical thinking that just comes naturally to talented analysts?
Moreover, what aspect of developmental thinking is helpful? Is it useful to know something about the impact of certain common experiences and when they occurred (such as sibling birth or death, divorce) or does such knowledge prejudice our listening and thinking, creating templates that force clinical material into what Jacob Arlow calls prescribed pathways? Is it helpful to think about the forward movement of developmental transformations of the mind? Does the developmental point of view have any bearing on how we arrive at genetic interpretations? Does developmental knowledge establish a set of propositions about “what is possible” and “what is normative” and are these helpful or constraining?
Karen Gilmore, M.D., is senior consultant at Columbia Center for Psychoanalytic Training and Research, served as director of the Child Division, is a training and supervising analyst and clinical professor of psychiatry at Columbia University College of Physicians and Surgeons.
Putting aside developmental curriculum for a moment, we are well aware that developmental theories exist, more or less, in every (pre-postmodern) psychoanalytic school and that these lead, either explicitly or implicitly, to those storied psychoanalytic babies, i.e., pictures of the infant mind derived from the fundamental theoretical assumptions central to each school.
There is the Freudian baby buffeted by drives and seeking stimulus reduction; the Kleinian baby tormented by aggression, utilizing projective defensive maneuvers from birth and possessing a perinatal consciousness of oedipal triangulation; the ego psychological baby equipped with emergent ego capacities which are recruited into conflict and compromise formation. Indeed, most so-called classical psychoanalytic schools (those that arose before the postmodern era) offer clear, albeit often unintegrated, propositions that describe the emergence of the human mind; these propositions deeply affect the way the adherent analyst hears, understands, conceptualizes, and approaches patients.
Interestingly, in 1905 infant and child observation was promoted by Freud himself to gain “a satisfactory degree of certainty” about central developmental hypotheses, but the usefulness of such observations and research has been hotly debated in the contemporary analytic world. Peter Wolff, a prominent infancy researcher/analyst published a paper entitled “The Irrelevance of Infant Observations for Psychoanalysis,” and asserted that the latter is concerned with “meanings, unconscious ideas, and hidden motives” all of which are inaccessible in infants. I will not here recap the lively exchange that ensued when eight prominent child theorists, researchers, and clinicians provided commentaries accompanying the publication of that paper. Suffice it to say neither Wolff nor his interlocutors changed their minds.
In a monograph dedicated to the same question some years earlier (The Significance of Infant Observational Research for Clinical Work with Children, Adolescents, and Adults), Arnold Cooper noted the inevitable presence of developmental theories, personal experience, exposure to developmental science, and culturally induced blind spots in clinical work. He wholeheartedly endorsed the importance of developmental education by his pragmatic assertion that developmental knowledge, from whatever source, scaffolds our thoughts about the genetic histories of our patients (and by extension, about transference manifestations) as these emerge in the clinical encounter. Absent education, this uninformed “knowledge” can only perpetuate some of the historical errors of our theory making, including assumptions about female development and homosexuality.
The counterpart of the question is whether psychoanalytic theory influences infancy observation and research; about this, there is little debate. Barbara Fajardo neatly demonstrated how different orientations inform the hypotheses, methodology, and observations of an infant researcher of a particular persuasion. Her position does not require choosing one or the other orientation, since she embraces a systems approach: Intersubjectivity, attunement, emerging ego capacities, primitive affect can all be integrated into an inevitably eclectic way of thinking and all find application in adult analytic work. Insights and meanings derived from the mother-infant relationship can illuminate aspects of the treatment relationship, but a study of development supports the important caveat that no adult behavior or relationship can ever be an exact replica of the infant antecedent; intervening development ensures that any apparent reenactment in the here and now is far more complex and multi-determined than the dynamics of the mother-infant dyad (however complex that too was likely to have been). Does making such links lead to misunderstandings and missteps in interpretation or does it inform the clinical analyst's empathic understanding? I have written that there is no question that developmental ideas can perpetuate errors in theory. It is harder to show whether the impact of developmental education results in a more grounded theoretical approach. Or does theory stand apart; is it impervious to developmental information?
In this regard, another study group project under way is the exploration of the relevance of developmental concepts to the “here and now” analytic work with adults. A few seminal developmental papers (from a variety of theoretical perspectives) will be chosen to illustrate the application of the developmental concepts elucidated therein to clinical examples from adult analyses.
We are hoping to develop other projects going forward. There is interest in assessing candidate exposure to contemporary revisions of hallowed psychoanalytic concepts that are intrinsically developmental and also influential in a wide swath of analytic theorizing. Scott Dowling, Lawrence Inderbitzen, and Steven Levy have examined how enlightened developmental thinking has elucidated the concept of regression, radically challenging the idea of a linear return to earlier mental organizations. Have these new ideas entered into analytic teaching and clinical thinking and helped candidates understand what happens to certain adult patients under stressful circumstances, such as an analysis? It seems evident that moments of what is typically described as regression invoke the analyst's understanding of prior modalities, but it remains to be studied how the analyst's hypotheses are modified and refined by new ideas and how this helps in the interpretive moment.