Suffering and bruised by enforced historical isolation, how has this plucky outsider—the William Alanson White Institute—managed to survive and to thrive?
Clara Thompson, Harry Stack Sullivan, Erich Fromm, Frieda Fromm-Reichmann, Janet Rioch, David McK. Rioch. In the fertile 1940s context of growing dissent and controversy in mainstream psychoanalysis, this somewhat raffish and intrepid group of colleagues, most of whom were classically trained abroad, all of whom had deep professional roots in the Washington and New York area, and almost all of whom were members of the IPA, fought for their professional survival. Their psychoanalytic bona fides qualified them uniquely to summon their liberal sensibilities on several fronts, daring to do battle with the increasingly entrenched rigidities of orthodox psychoanalysis.
Clara Thompson, M.D.: First director of the White Institute (WAWI), she was a charter member of the Washington Baltimore Society (WB) and its first president and a faculty member of the New York Psychoanalytic Institute (NYPSI). Thompson had over a period of several years, traveled to Budapest for a personal analysis with Sandor Ferenczi, returning to teach some of Ferenczi’s challenging technical innovations, which she and Harry Stack Sullivan, as well as Ferenczi, thought remarkably close to Sullivan’s approach to severe disturbance. She taught with Karen Horney at NYPSI and joined Horney in protest against Horney’s being stripped of her TA and faculty privileges.
Harry Stack Sullivan, M.D.: Urged by A.A. Brill to form the WB Society, he joined Thompson as a charter member. In addition, Sullivan served in 1930 as an APsaA vice president, under Brill’s presidency, and continued as a TA through the 1930s and 1940s. His pioneering work with a young, male schizophrenic population at Shepard Pratt Hospital in Baltimore, and his subsequent work with regressed and acutely ill psychotic inpatients at Chestnut Lodge, formed the clinical basis of his “interpersonal psychiatry,” offered as a powerful alternative to the orthodox psychoanalytic position that psychoanalysis was the treatment of choice only for psychoneurosis.
Frieda Fromm-Reichmann, M.D.: Trained at the Berlin Institute, upon emigrating to the U.S., she began working at Chestnut Lodge, collaborated closely with Sullivan, and became an admired clinician widely known for her insightful and empathic approach to working with schizophrenic young people there. Modestly, she referred to her work with patients as “intensive psychotherapy,” which she continued for many years, even through periods of psychotic regression. At the WB Institute, she became a TA and served as a long-standing member of its Education Committee.
Erich Fromm, Ph.D.: Fromm merged his background in social psychology (his doctoral specialty) with his classical Freudian training at the Berlin Institute. Upon emigrating, he accepted Franz Alexander’s invitation to teach as one of
the first faculty members at the Chicago Institute, where he met Karen Horney. He eventually settled in New York City in 1934, where he developed his concepts of unconscious drives as reflections of the social context of the surrounding culture. Rejecting the primacy of libido theory that had dominated American psychoanalysis, he regarded ego psychology as a sterile adaptation by orthodox psychoanalysis to the demands of American academia.
Ultimately, this group was joined by some colleagues from the Washington School of Psychiatry (WSP), notably Janet Rioch, M.D., and David McK. Rioch, M.D., who brought some of the concepts of systems theory and organizational dynamics into alliance with the growing school of interpersonal psychiatry, an approach that privileged the exploration of unconscious aspects of relationships, including the present tense “here-and-now” dimension of the patient-psychoanalyst relationship.
These dissidents took issue in various ways with increasingly entrenched and rigid trends in organized mainstream American psychoanalysis, including:
medical orthodoxy in training centers;
dogmatic insistence on the primacy of “libido theory” and the “Oedipus complex” in psychoanalytic understanding;
persisting acceptance of Freud’s beliefs that psychoanalysis was not feasible with borderline conditions, narcissistic, schizoid and other character disorders, or schizophrenia;
and the reified belief in the need for the analyst to remain an anonymous and neutral presence, in order to achieve a therapeutic effect.
By 1941, the palpable challenge posed by the broad impact of interpersonal thought was being felt in more orthodox quarters. In a contretemps dubbed by John Frosch, in 1991, “the New York psychoanalytic civil war,” NYPSI’s leadership encountered Horney’s radical challenge to the orthodoxy of libido theory, emphasizing instead cultural influences on personality development. Her growing popularity and influence among candidates led to an organizational struggle in which Horney, whose thinking was closely aligned with that of her more liberal colleagues, was stripped of her teaching privileges and TA status on the grounds that she was “disturbing” students. The vote was 24–7, with 29 abstentions.
Joined by Clara Thompson and four other faculty, as well as 14 candidates in analysis and supervision (whose educational progress had been judged inadequate and hence were unable to graduate), Horney left NYSPI to lead as dean, a new psychoanalytic institute, the American Institute of Psychoanalysis (AIP).
Oral historians recall the triumphant, exuberant protest march of this aggrieved group of dissidents down Fifth Avenue singing “Go Down, Moses,” underscoring the concern for academic freedom against paternalistic authority.
Horney and colleagues wrote eloquently and passionately to all APsaA members, decrying the impingements on academic freedom they perceived at NYPSI. A second split from NYPSI one year later, similarly decrying “rigidity” and a “stifling atmosphere,” led to the founding of the Association for Psychoanalytic Medicine and its training institute at Columbia.
Sullivan and others from the D.C. area initially joined with the new Horney institute. When APsaA resolved in December 1941 that membership in APsaA was incompatible with membership in a rival association, Sullivan resigned from the Horney group in order to preserve his membership.
Fromm’s dissenting slant on classical psychoanalysis was compatible with that of the Horney group, with which he also affiliated. Despite his Berlin training credentials, as a non-physician, he was not permitted to join APsaA. His involvement with Horney’s group, especially on the heels of his new and remarkably prescient 1941 exploration of the psychodynamics of Fascism and its leadership in Escape from Freedom, generated enormous enthusiasm and interest among candidates. Horney, who was reportedly concerned with his popularity, as well as about his presence endangering hospital affiliations, apparently engineered the stripping of his TA privileges in 1943.
Fromm…with Thompson, Sullivan and Fromm-Reichmann formed a new training facility in New York City in 1943.
Fromm’s demotion and exclusion prompted a split at the Horney Institute, bringing Fromm together with Thompson, Sullivan and Fromm-Reichmann to form a new New York City training facility in 1943. Initially, this group affiliated with the Washington School of Psychiatry (WSP) as a parallel institution, known as the “New York Branch” of the WSP. The WSP embodied Sullivan’s vision of teaching interpersonal psychoanalytic ideas to people in related fields. Many who trained in those years recall there was much overlap in curriculum and faculty between the WSP and the WB, sometimes blurring boundaries completely. New York City candidates were automatically enrolled as candidates in the WB Institute, traveling to D.C. for supervision, and Sullivan and Fromm-Reichmann traveled regularly to New York City.
To avail veterans of educational benefits, Thompson’s group sought and obtained an independent charter from New York State in 1946, for the William Alanson White Institute of Psychiatry, later adding “Psychoanalysis and Psychology” to its name. From 1946-1948, the new White Institute candidates continued to be enrolled in the WB, which considered WAWI as its New York branch. The WB included White’s course offerings in its own bulletin and sponsored its graduates for APsaA membership. The earliest graduates of this new institute were admitted pro forma to APsaA, in keeping with then-existing APsaA rules.
A 1946 rule change required separate approval for membership beyond simply graduating from a member institute. This change created difficulties for the next crop of the institute’s graduates, as did a contemporaneous split between the Washington and Baltimore groups. By 1950, however, nine of the institute’s graduates and faculty had been admitted to APsaA membership, enough to qualify WAWI as a society in its own right, according to APsaA’s then-existing rules.
In 1948, embroiled in internal struggles having to do with the disfavor with which conservative APsaA forces looked upon Sullivan’s work, the WB declined to accept as its own candidates those from WAWI or those who had already been accepted and begun training. It was suggested that WAWI apply for independent status as an APsaA training institute. WAWI was promised sponsorship of this application by WB, and others, including APsaA President-Elect Robert Knight, whose election was hailed as ushering in a new era in intellectual sophistication for APsaA. Knight reportedly told Clara Thompson he regarded the application as a mere formality and that he was friendly to supporting it.
Having four TAs recognized by APsaA and 30 candidates registered in the WB, WAWI made formal application for recognition in November 1948. Sullivan’s sudden, untimely death in 1949 resulted in the unravelling of an uneasy alliance between the Washington group (including Sullivan, Fromm-Reichmann, the Chestnut Lodge contingent, Thompson and others) and the Baltimore group, seemingly dominated by the Viennese émigré Jenny Waelder-Hall. Apparently under pressure from the Baltimore contingent, WB decided to drop the 30 candidates from WAWI in the midst of their training. At around the same time (1949-1950), BOPS adopted the geographical rule, designed to limit the power and autonomy of individual institutes next to the increasingly centralized power of the Association. Significantly, this rule was promulgated over one year after the WAWI application for membership/affiliation, and was applied on an ex post facto basis. Of relevance, also, the WB’s New York branch was the only APsaA training center in the U.S. operating under the aegis of an institute in a different geographical region.
From 1946-1948, the new White Institute candidates continued to be enrolled in the WB Institute, which considered WAWI as its New York branch.
An additional APsaA rule for new institute applications, adopted in 1949 (also one year after the WAWI application was submitted) required the endorsement of two other member institutes. Based on a catalog description alone, with no discussion, the NYPSI decided the curriculum at WAWI was insufficient. Columbia, which had cordial relations with WAWI based on a shared history of dissent from orthodoxy and a split from NYPSI, agreed to provide this endorsement.
One year later , three TAs of WAWI were suddenly dropped as TAs by the WB, ensuring—from a technical point of view—that they were no longer recognized by APsaA as TAs. That same year, the Committee on Institutes (COI) decided to defer a definite decision on the WAWI application for an additional two years (thus, minimally, four years in all) in order to gain more time for investigation of “certain important data”). After repeated delays by APsaA, a WAWI representative met in Chicago with the chair and secretary of the COI, clarifying that APsaA’s stated concerns included reservations about the training of clinical psychologists. In addition, they requested further statistics on the
physician candidates graduated since 1948 and the 11 physicians in training in 1951. They suggested a reorganization of the course “Bulletin” to present offerings for medical candidates only, and that Erich Fromm (a non-physician) not be listed in the “Bulletin.”
The COI chair Therese Benedek further stated in a letter to WAWI that in addition to the problem that three TAs were “geographically annihilated,” the absence of a new four-to-five-hour rule in White’s training standards would result in rejection of the application. She added the further suggestion that Erich Fromm be dropped as a TA, since he was a “lay analyst” and he conducts “unrecognized training” in Mexico. Her letter hinted broadly that changing the institute’s training “standards” would clearly help to get WAWI recognized by APsaA. Thompson’s reply corrected Benedek’s erroneous inference that WAWI had “decided not to cooperate with” the four-to-five-hour rule “binding on all training organizations,” affirming that WAWI never took that position but simply had not discussed the matter further “since the decision taken by the American in regard to the appointment of TAs, the affiliation of students and the formation of a society deserve… prior consideration.”
APsaA was engaged in a charade around so-called minimum standards, with extensive awareness that frequency of practice varied widely across APsaA institutes and in Europe. Freud’s growing practice (initially, six sessions weekly) had given way to the pragmatic decision (neither scientific nor evidence-based) to work at a five-times weekly frequency to accommodate four Americans who arrived in Vienna in 1921, enabling him to see nine patients in psychoanalysis. Sometimes publicly acknowledged, analysts continued to practice three-times-weekly psychoanalysis.
In 1948, BOPS described the training analysis as “a dynamic procedure determined by the dynamic needs of each person. Any statement of a definite number of hours of analytic treatment is incompatible with this concept.” However, in 1951, BOPS passed a resolution changing its minimum standards requirements to the expectation of “a minimum of four hours a week, an optimum of five,” for training and control analysis. This resolution unleashed a storm in APsaA, led by the Chicago Institute asking that the new standard be withdrawn.
Of APsaA’s 11 institutes, four of the most liberal (Chicago, the Washington division of WB, Southern California and Columbia) joined in opposition to uniform rules and rigid prescriptions for training, in favor of flexibility, decrying the threat to autonomy of individual institutes to define their own training methods and practices. Chicago’s statement referred to the practice at the Berlin Institute, “where the general policy was to see cases in control analysis three times a week and to deviate from this baseline according to indication.”
At a pivotal meeting between the COI and WAWI (November 1952), WAWI made one final attempt to overcome the array of obstacles. WAWI pressed its claim that the requirements met by WAWI upon application had been changed mid-stream. WAWI confronted the COI with the facts that the geographical rule was “used with elasticity” with two other groups (Seattle and New Orleans), where no training institute yet existed, in which faculty were imported to serve APsaA’s desire to “colonize” these areas. One COI member disclosed, for the first time, “people having to do with such matters at the time did not consider valid Freudian analysis was being taught at the WAWI.”
…four years after the institute applied for recognition in 1948, Thompson wrote to the Association formally withdrawing the White Institute’s application.
Repeated obfuscations, obvious in the transcript of this meeting, prompted one APsaA representative, Merton Gill, to speak with clarity and in frustration, emphasizing he was speaking for himself only, and not for the committee:
…the objections I have heard here… deal with such legalistic matters as the geographical rule or the number of hours. However, there is a serious cleavage in principles and I think that the American chooses to regard itself as a group of people who believe in a certain kind of analysis, and groups who deviate from these ideas should not be members.
I think this group has a legitimate grievance. I think there has been something of a run-around and if it is true that this is the issue of deviating so widely, …if this is indeed the reason for which this group should be excluded from the American, then this group is entitled to be told that in so many words.
…if a group feels that it is being judged on principles and not on form, then there is very little incentive to follow form.
At this point, Benedek stated: “When you don’t have the same scientific principles, then the cleavage is really very great, much greater than one would be able to bridge.” Norman Reider added: “There is a divergence in the American
Psychoanalytic but the divergence of this group seems to be considerably more quantitatively and qualitatively from others in the group.”
Two weeks after this meeting, four years after the institute applied for recognition, in 1948, Thompson wrote to the Association formally withdrawing the White Institute’s application. Citing having been prejudged, without the issues being clarified, she noted several “other institutes with no better qualifications were accepted,” and cited Gill’s clarifying remarks: “This finally makes the situation perfectly clear to us…we see clearly that, under the circumstances, our institute does not belong in your Association… [and that] under the circumstances, an evaluation by you of the competence or incompetence of our teaching program is irrelevant.”
APsaA moved in a still further regressive direction, shortly after this meeting, in December 1952, as BOPS resolved “analytic training except under the auspices of Accredited Institutes is against sound policy…that training in therapeutic psychoanalysis is a function of the authorized Institutes of the American…and not of the training analyst as an individual to carry on therapeutic psychoanalysis except under the direct auspices of a recognized Institute of this Association.” BOPS directed member institutes “to inform [its] Committee on Ethical Standards of any violation of this resolution.”
Despite WAWI’s difficult but inevitable decision to pursue its own path, as an autonomous and free standing institute, such challenges to academic freedom continued from APsaA. Extending the 1952 scope of its concern with the purported ethical problem of teaching outside of APsaA’s own institutes, BOPS pursued, in 1954, a formal definition of teaching at an “unrecognized institute” as “unauthorized” and “inconsistent with the responsibilities of membership.” BOPS pushed to have these restrictions codified in a proposed change in APsaA’s bylaws. The consequence of such “unauthorized training activity” would be the loss of membership for the individual in both the local society and the Association and ultimately, withdrawal of the recognition of any institute condoning such ethical violations. Work with a TA judged guilty of such behavior would only be credited for candidates “up to the point of suspension…but not thereafter.” This stipulation would require that candidates leave their TAs if they wanted credit for that aspect of their training.
Several prominent WAWI faculty belonged to APsaA societies and felt they could not jeopardize their membership in their local society if this proposal were to pass through the required two-thirds vote for a bylaws amendment. WAWI engaged its trustee, former Supreme Court Justice Abe Fortas, who warned APsaA the implementation of this code might be a violation of the Sherman Antitrust Act, outlawing monopolistic restraint of trade. When the proposal for a bylaws amendment was submitted to the membership in 1956, it fell short of a two-thirds majority, defeating the efforts of those within the Association who were proponents of this coercive assault on academic freedom through a proposal for centralized control over who could teach and where.
Over the subsequent 40 years after withdrawing its application, WAWI pursued the development of a rigorous and intellectually rich training model, reflecting the contributions of a growing and influential cadre of interpersonal and relational psychoanalysts, while continuing to teach the Freudian perspective, emphasizing both commonalities and differences. In the context of taunts and derisive insults about not teaching real psychoanalysis, and of being professionally ignored and demeaned, WAWI members understood that the struggles and challenges of being excluded and isolated facilitated the institute’s developing a distinct and compelling point of view. WAWI members remained mindful of the growing interest from other organizations to learn from this increasingly compelling model.
The 1995 proposal for revisiting a possible affiliation from then-President Marvin Margolis was clearly a response to the lawsuit APsaA had defended against the successful contention of four Division 39 members alleging monopolistic restraint of trade. Against the historically painful process of “longing, but not belonging,” a series of meetings did occur in the mid-1990s, resulting in a BOPS Task Force on Accreditation of Established Institutes. WAWI’s good faith participation in these meetings led unfortunately to a 1999 report, named for the task force chair, David Carlson, that dashed some burgeoning hope stirred by the liberal APsaA initiatives.
The Carlson Report recommended the establishment of a standing committee of BOPS, the Committee on the Accreditation of Freestanding Institutes (CAFI), with articulated procedures for facilitating APsaA affiliation. Unfortunately, these procedures were not welcoming, as they constructed hurdles and obstacles that would effectively undermine the autonomy and uniqueness of the training model WAWI had evolved. Even the most liberal APsaA
members hoping for a rapprochement commented that any prospect of engaging WAWI was now, in the words of one, “dead in the water.”
Despite the understanding that the Carlson Report sounded the death knell for any prospective affiliation, several BOPS and CAFI members and officers …worked successfully toward rescinding the Carlson Report in the late 1990s.
The frequency issue continued in the Carlson Report to dominate APsaA’s stipulation: “Training analyses and supervised cases henceforth to be conducted according to the American’s 4-5x/week standard. In return, the American would grandparent as provisional training and/or supervising analyst any training and or supervising analyst participating in, or indicating her/his acceptance of, the new policy.” The process proposed also required a site visit from the COI, with the clear implication that WAWI was not yet ready to be admitted to APsaA as an accredited institute.
Despite the broad understanding that the Carlson Report sounded the death knell for any prospective affiliation, several BOPS and CAFI members and officers who favored bringing WAWI into the fold, worked successfully toward rescinding the Carlson Report amidst further meetings with WAWI in the late 1990s. Collaborative exchange, in the context of a shared experience of good faith, enabled an effective working relationship that ultimately led to the invitation that was based on acknowledging the need for WAWI to be accepted “as we are,” based on a liberal definition of the validity of different training models.
BOPS constituted a joint APsaA-WAWI Task Force on Training Models (in 2008) to explore further and in detail all aspects of the respective training models each organization utilized. In its 2009 summary report based upon the close examination of training models, the task force affirmed “remarkable congruence in the training models of each organization” and “a shared psychoanalytic sensibility and fundamental kinship regarding educational values, including a commitment to immersion in the process of education and training.” It concluded: “Our kinship as psychoanalytic educators differentiates us from other training models that do not link a deep immersion in psychoanalytic sensibility to the process of exploring the inner world…. We regard differences in training models…[as] relatively minor and not truly differentiating. Training models in both organizations reflect a shared commitment to excellence in training, embodying the values of rigor, deep immersion, and quality.” BOPS received this report and its recommendation to invite WAWI to join APsaA unanimously and enthusiastically, along with CAFI’s proposal that the “White Institute model” be endorsed as an Eitingon model “variant,” in connection with a formal invitation to join APsaA as an “approved institute.” The invitation explicitly “recognizes the William Alanson White’s model of training in psychoanalysis as a coherent, evolved, and integrated training process,” which was to be formalized in a revision of BOPS’s Educational Standards document, with the additional provision that any APsaA-approved institute wanting to adopt the White Institute model in its entirety may do so. (The subsequent admission of AIP was based on its embrace of changing its training model to the White Institute model.)
WAWI’s early 1950s decision to remain an autonomous and freestanding psychoanalytic training institute was hardly a rejection of the APsaA training model. White’s training model was formed in close affiliation with the early WB implementation of the tripartite Eitingon model. This model has guided WAWI’s structure and training requirements for more than half a century. Given psychoanalytic ancestry and lineage, it is relevant to consider that these organizations share the same institutional DNA, and White’s training practices have been in many ways comparable to and in some ways more rigorous than those of APsaA approved institutes. WAWI has embraced heterodoxy rather than orthodoxy for candidates in training, and its faculty includes many who regard themselves as Freudian in addition to those who consider their orientation to be interpersonal or relational.
WAWI’s prodigious contributions to the psychoanalytic literature are very well known
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WAWI’s prodigious contributions to the psychoanalytic literature are well known internationally; its journal, Contemporary Psychoanalysis, has maintained an eclectic focus for more than 50 years; educational programs have blossomed beyond the flagship four-to-six-year psychoanalytic institute training program, joined by a three-year Child and Adolescent Psychotherapy Training Program, a one-to-two year Intensive Psychodynamic Psychotherapy Program, a one-year Eating Disorders, Compulsions and Addictions Program, as well as a wide array of regularly scheduled conferences, workshops and topical study groups. Classrooms are full and graduates are prospering.
Notably, WAWI’s psychoanalytic training program has set minimum standards for clinical training that exceed IPA standards and are more demanding than APsaA’s traditional standards: a minimum of four supervised training cases, with at least three different supervising analysts, for a total of 200 supervision hours. Treatments are conducted either on the couch or face-to-face, with such technical decisions emerging from collaborative exchanges between candidate and supervising analyst, based on a shared sense of what is clinically indicated. Training cases are required to be seen at a frequency of at least three hours weekly, as a minimum. WAWI’s integrated model of training reflects a persisting belief that psychoanalytic training requires rigorous standards and embodies a conviction an institute can be trusted to develop quality programs and to integrate rigor into the training experience without oppressive oversight.
WAWI’s selection process for SA/TA appointment requires clinical presentations to a small group of colleagues. The training model has defined psychoanalytic practice in terms of its intrinsic qualities, not primarily based on such extrinsic factors as frequency or the use of the couch, but rather on the basis of depth, intensity, immersion and facility with eliciting and working with the unconscious process.
WAWI was one of the first institutes, in 1948, to develop a “low cost treatment service,” offering intensive psychoanalysis, providing a community service as well as helping candidates with opportunities to conduct long-term analyses. Notably, the training model also includes a psychotherapy requirement of one year of supervised experience conducting psychotherapy, emphasizing the ways in which application of psychoanalytic principles can inform and enhance the therapeutic efficacy of psychotherapy. WAWI’s unique heritage and legacy, enabling sometimes daring work with more disturbed patients, is reflected in training in clinical approaches to a wide range of difficult patients who present with singular challenges for which orthodoxy in technique is inappropriate.
Distinct from the typical structure of many APsaA and IPA institutes, the WAW Psychoanalytic Society has no formal role in administration of the institute, although the institute and society generally maintain a collaborative, mutually supportive relationship. The society, consisting only of psychoanalytic training program graduates, currently numbers more than 200 graduates who have remained active and/or affiliated with the institute. For at least several decades, WAWI has been widely regarded as the premier postgraduate psychoanalytic training program for psychologists, dating to a time when prestigious and well-known programs nationwide were not accepting psychologists for full training.
Considering institutional history, the decision to accept APsaA’s invitation has been controversial. Among the articulated concerns is that the defining spirit of dissent and academic freedom may be at risk of being compromised. On the other hand, the virtually unanimous endorsement by APsaA’s Executive Council and BOPS, the significant understandings APsaA offered, including grandparenting existing SAs and TAs, extending BOPS certification to WAWI SAs and TAs, and using APsaA’s best efforts to enable IPA membership for all WAWI graduates who join APsaA have been accepted by many at WAWI as meaningful steps in the direction of reconciliation and reparation.