As a first-year medical student, Yuki met Himanshu at a networking dinner for psychiatry and heard about his extremely long and as-yet-unfinished journey in psychoanalytic training. She remembers how overwhelmed she had been feeling at that time, gauging all the training it would require just to become a physician. This initial meeting left her curious—what could be so compelling about psychoanalysis that it would drive someone to commit to such an endeavor, on top of their arduous medical training?! Three years later, as a senior medical student applying to psychiatry residencies, Yuki returned to this conversation with Himanshu, who was now an advanced candidate and had recently completed two years as a candidate director-at-large on the APsaA Board of Directors.
Meanwhile, Himanshu had been having similar conversations with his long-term friend Nick, who was a therapist contemplating psychoanalytic training and the president-elect of the Minnesota Psychoanalytic Society.
In his article titled “The Triumphs and Tribulations of Being a Psychoanalytic Candidate” published in TAP (Spring/Winter 2002), Himanshu described the factors in his decision to apply for psychoanalytic training. He asserted, “Every potential candidate may have important reservations and many of these are arduous to overcome, and sometimes seem insurmountable.” As Yuki, Nick, and Himanshu reacted to this article separately, they realized they were wondering about the same question: what drives the modern psychotherapist toward the rigorous task of psychoanalytic training, and what drives them away from it?
Himanshu introduced Yuki to Nick and—long story short—the desire to quench this curiosity manifested itself as an Institutional Review Board–approved national survey of prospective candidates (IRB PRO ID # PRO00043444, Medical College of Wisconsin). This survey sought to identify the main motivations for pursuing psychoanalytic training, along with major detractors that tend to stand in the way of taking the plunge. Additionally, free-text comments from the respondents provided illuminating insights into the perceptions, attitudes, fears, and desires of the contemporary prospective APsaA candidate. As far as we know, this is the first survey of its kind in the United States. Although a similar survey was conducted by Debra Katz and colleagues in 2012 (published in JAPA 60:5), it involved individuals who were already in psychoanalytic training.
Our study used an anonymous, secure survey platform (Qualtrics) to gather cross-sectional data, which included some demographic data, and asked participants these two main questions:
What are some factors that make/have made psychoanalytic training APPEALING for you? (Please rank them in order by dragging the options up and down, with Rank 1 being “most appealing factor.”)
What are some factors that make/have made psychoanalytic training UNAPPEALING/ a HINDRANCE for you? (Please rank them in order, by dragging the options up and down, with Rank 1 being “most unappealing factor/ biggest hindrance to applying for psychoanalytic training.”)
Participants were also given the opportunity to enter free-text comments. The informed consent and invitation to the anonymous survey were posted on the APsaA members listserv and were addressed to individuals who may be contemplating/have ever contemplated psychoanalytic training but have not pursued it thus far. The authors collected data over a period of three months in 2022.
A total of 120 responses were collected and analyzed. The demographics are displayed here.
Next, we share the findings of the survey wherein prospective candidates ranked appealing and detracting factors about the prospect of applying to psychoanalytic training.
Chart 4 shows the distribution of potential appealing factors related to psychoanalytic training of responses for each of the nine choices we offered, from 1 as most appealing factor to 10 as least appealing factor. Participants were given the opportunity to enter their own free-text responses, which are addressed in a separate section.
Chart 5 shows the distribution of potential detracting factors related to psychoanalytic training of responses for each of the nine choices we offered, from 1 as most detracting factor to 10 as least detracting factor. Again, participants were given the opportunity to enter their own free-text responses, which are addressed in a separate section.
The comments that were submitted focused mainly on negative factors, touching on three main themes.
The first theme was the logistical difficulties related to psychoanalytic training, that is, the feasibility of psychoanalytic training in contemporary times. These comments included
“Been longing for training for years. Out of reach financially.”
“The primary obstacle for me in reference to psychoanalytic training has been the commitment of cost. I believe there should be more ways of supporting candidates that don't involve going into debt, such as scholarships, lower fees, etc. I believe this is one of the challenges in terms of increasing diversity in candidate cohorts.”
“Not easily feasible for tenure track faculty.”
“In addition to the cost of the training analysis is the inflexible requirement of in-person sessions 4x week. As someone from a rural community with an interest in distance training, I would not be able to meet the in-person requirement.”
“Many programs require the training analysis to take place in person, and that is not a possibility for me. Distance programs are appealing, and I've gotten a lot out of distance ed courses through various institutes, but I hesitate to commit to a longer analytic training program offered in this format.”
“At the time I considered this possibility, I was already in my 50s and an established psychoanalytic psychotherapist. I did not think that the benefits outweighed
the various kinds of costs (of formal analytic training).”
“…volume of reading.”
“I think if I were 20 years younger, I would pursue analytic training. At this point in my life, I'm working on enjoying life and work without feeling pressured by training costs (both financial and time).”
The second theme focused on the toxic culture within psychoanalytic training. Comments included
“The way one is judged.”
“At my local institute the squabbling is sad …Training is structured around an old system that does not reflect a social or economic reality for most.”
“Rigidity, authritarianism [sic], bias, cultural insensitivity, inflated egos of some supervisors and faculty. Infantilization of candidates.”
“Sadly, the culture at my institute exemplufied [sic] not the ideals of inclusion, egalitarianism, and open-mindedness but rather exclusionary and close-minded thinking. It's difficult to imagine learning much in an analytic ‘war zone’ where egos supersede all else.”
“Frequent displays of racism, sexism, homophobia, transphobia, Islamophobia, classism, simple tastelessness, arrogance, general defensiveness, malignant narcissism, and general disrespect for colleagues among graduate analysts, particularly on the APsaA listservs, drastically decrease my motivation to complete training. Over time I see less and less how being called a graduate analyst can be considered an accolade on its own.”
The third theme involved the negative reputation of psychoanalysis in contemporary society. Comments included
“I don't expect an improved reputation to come from analytic training, rather the opposite in my circles. And the main reason I want to do it is to better understand the world and help people, nothing to do with money or respect.”
“Resistance to incorporating findings from academic psychology and neuroscience”
Based on the response of these 120 participants, the findings of this survey suggest to us three things.
First, personal and professional growth through each of the three legs of the tripartite model of psychoanalytic training remain the most appealing factors for prospective candidates. Out of these three, the most appealing aspect of psychoanalytic training is lectures or didactics offered as part of the training, followed closely by the value offered by individual, longitudinal supervision on analytic cases, followed closely by the appeal of one's own training analysis.
In 2022, potential candidates placed great importance on the in-depth lectures and didactics in psychoanalytic training. This finding comes as a bit of a surprise to us, since it is often said in psychoanalytic circles—much to the annoyance of our hard-working lecturers—that the lectures/didactics are “the least useful” of all three components of psychoanalytic training. Perhaps the opinion of the respondents might change as they progress through psychoanalytic training, or perhaps this finding reflects how the current generation of potential candidates is truly different from the generations that came before them.
Second, in 2022, prior/current personal analysis was not a very important factor for potential candidates while considering the appeal of psychoanalytic training. In our opinion, this issue needs to be explored in more detail, since this may have implications for the future of psychoanalysis. Whereas a few decades ago it was commonplace (if not mandated) for many psychoanalytic candidates to have already undergone a personal analysis, this may no longer be the case today. In an industry dominated by health-care businesses pushing short-term psychotherapies, psychoanalysis is becoming increasingly cost-prohibitive to members of society. One wonders how this might be influencing an individual contemplating psychoanalytic training.
Third, potential psychoanalytic candidates today are not much allured by the prospect of a psychoanalyst garnering higher respect from their patients, colleagues, or society in general. We suspect this to be related to a multitude of factors. As the emphasis on psychopharmacology and “evidence-based treatment” grows, the number of individuals practicing psychoanalysis is dwindling. Having said that, the history of exclusion, authoritarianism, and elitism associated with organized psychoanalysis has likely not helped the reputation of psychoanalysts in an increasingly well-informed world.
For better or for worse, the themes elicited from prospective candidates seem to be largely unchanged when compared with the themes reported by candidates in the 2012 Katz survey. Thus, we find ourselves reiterating many of the same suggestions offered by Katz and colleagues a decade ago. We also offer our opinion on which
specific areas for improvement the interventions might target.
This 2022 national survey of prospective candidates replicated findings of the 2012 national survey, suggesting that although psychoanalytic training remains appealing to many individuals across the United States, the challenges of cost, the dwindling reputation of the effectiveness of psychoanalysis, the burden psychoanalytic training places on life outside of training, and the perception of a toxic culture continue to be on the minds of prospective trainees. Important steps are being taken at the national and local levels to address these challenges. We feel that these steps need to be highlighted, disseminated, and bolstered so that our beloved craft may continue to evolve.
Yukino Strong is a student at Medical College of Wisconsin seeking a psychiatry residency. She majored in neuroscience at Brigham Young University. Her interests within psychiatry include psychotherapy, forensics, perinatal health, and global mental health.
Nicholas Flier is a psychodynamic psychotherapist and clinical supervisor in Minnesota and Wisconsin. He is currently serving as the president of the Minnesota Psychoanalytic Society. He is a member of APsaA as a Psychotherapist Associate.
Himanshu Agrawal is an associate professor of psychiatry and behavioral medicine at the Medical College of Wisconsin. He is a former candidate-at-large of the APsaA Board, serves on several APsaA committees, and is the incoming president of the APsaA candidate council.
| Intervention | Target Area |
|---|
| Reduce costs. | Feasibility, Culture |
| Address infighting and toxicity through standardized practices and policies, in person as well as online. | Culture, Reputation |
| Increase outreach and publicity. | Reputation. Culture |
| Improve teaching; optimize volume of didactics. | Feasibility, Culture, Reputation |
| Enhance exposure to enthusiastic analysts. | Reputation. Culture |
| Publicize psychoanalytic research. | Reputation, Culture |
| Embrace technology and integrate it into psychoanalytic training. | Feasibility, Culture, Reputation |
| Acknowledge, embrace, and empower life outside of psychoanalytic training; directly address the culture of machismo in psychoanalytic training that threatens work-life balance. | Feasibility, Culture, Reputation |
“MSWs weren't able to apply. LGBT therapists weren't welcome to apply.”
“One of the main things I want to learn/explore in a training analysis and supervision is racial identity and whiteness, but it's almost impossible to find a training analysis at a local institute who has done the work to make this a possibility. They say they are willing to do that work ‘if it comes up,’ but think very concretely about it, ironically not understanding that it always comes up, even if unconsciously, and if they can't notice that, then we can't do the work …”
First, personal and professional growth through each of the three legs of the tripartite model of psychoanalytic training remain the most appealing factors for prospective candidates.
“I inherited a patient from a highly respected analyst in my community … The analyst and I have since been able to discuss his progress … and the analyst admitted to me that he was there for so long so she could graduate. This is not [an] isolated [incident] …”