Psychoanalytic training today.

Psychoanalytic education in the United States faces multiple challenges as we enter the last decade of this century. (1) Changing interest and career path patterns for psychiatrists have resulted in fewer medical applications for psychoanalytic training. (2) Increased opportunities for full psychoanalytic training of nonphysicians have resulted in increased applications from highly skilled clinicians who often have more clinical experience than their medical colleagues. (3) Increased enrollment of women candidates has required rethinking of progression requirements, in light of their combined careers as professionals and mothers. (4) Independent institutes not accredited by the American Psychoanalytic Association compete for applicants while maintaining training standards that require less time and immersion in psychoanalytic theory and practice. (5) Economic factors increasingly influence the desirability of prolonged psychoanalytic training and the availability of suitable analysands for control analyses. (6) Evolution of theory and practice and the emergence of "new schools" of psychoanalytic thought have rendered the previous psychoanalytic landscape dominated by drive theory and ego psychology more multifaceted and less uniform. The American Psychoanalytic Association and its institutes attempt to understand these changing patterns and take them into consideration in the design and implementation of psychoanalytic training programs. Only one aspect of this complex situation will be described in this work, the current state of psychoanalytic training in the 28 institutes accredited by the American Psychoanalytic Association. Although the data available at this time leave unanswered many important questions about the philosophies that organize the content and emphases of the curriculum in different institutes, much has been learned about the overall structure of psychoanalytic training programs.     

The coming changes in psychoanalytic education: Part II

This paper is the second part of a general analysis of problems in contemporary psychoanalytic education. Having proposed changes in the training analysis and supervisory systems in Part I, here the author focuses on concrete proposals regarding changes in the curriculum, seminars and classroom teaching; the governance of psychoanalytic institutes, relationship of institutes with their respective psychoanalytic society and the role of the university in the development of science and research; the admission, progression, and graduating processes; certifi cation and accreditation.     

Teaching the Candidate in Case Seminar

There has been insufficient focus on the impact and usefulness of the case seminar for teaching in psychoanalytic institutes. In order to better understand case seminar, questionnaires were submitted to candidates, graduates, and faculty in two psychoanalytic teaching institutes. The responses indicate that the case seminar format should be standardized; level of experience of candidates should be similar; professors should examine suitability of the case beforehand; and candidates need to be prepared for the group process. Findings are useful in improving the teaching of psychoanalysis and encouraging the creative use of the candidate's self in psychoanalytic training.     

Psychoanalysis in the university: A full‐time vision1

Psychoanalysis may be unique among scholarly disciplines and professions in having grown as an educational enterprise in a private part‐time setting, outside the university. Freud would have liked it to be otherwise, but in Central Europe, when it was created, university placement was not possible. In America, after World War II, the concept of the medical school department of psychiatry psychoanalytic institute was established in some psychoanalytic training centers but it could only partly overcome the educational and research inadequacies of traditional psychoanalytic training. The possibilities for a true university‐based full‐time training structure are explored.     

Sollen Psychoanalytiker Psychotherapeuten ausbilden?

With respect to the radical changes in psychotherapeutic education as a consequence of the Law for Psychotherapy that has been put into force, the author elaborates on political, medical and strategic aspects. It is of special interest whether psychoanalysts having had the “monopoly” of training in depth psychological therapy should further take responsibility for the training in and the development of this method. Meanwhile, other therapeutic schools are claiming depth psychological psychotherapy for themselves and they deny the essential role of psychoanalysis as a foundation of it. In addition, the psychoanalytic institutes themselves do not agree on this issue. A further aspect of the question is that of marketing strategies: in order to survive, it is for psychoanalytic institutes at a time of lessening interest in standard psychoanalytic training important to offer training in depth psychological therapy with its comparatively less expensive and less extensive curriculum. But the essential question remains: should psychoanalysts train psychotherapists and take responsibility for an independent depth psychological therapy, or not? The author calls for a separate profound education in depth psychology taught by psychoanalysts in order to maintain a positive atmosphere for psychoanalysis e.g. in clinical institutions. He agrees with the IPV that this would help to solve “the crisis of the psycho analysis”. Finally, some of the most important, unsolved questions referring to a separate and profound education in depth psychology are presented and possible solutions are offered. It is of crucial importance to take up again the discussion within the psychoanalytical associations and to adjust their medical as well as political attitude to the new ways depth psychology is taught at psychoanalytical institutes.     

Identität, Familie, Patienten, Olympier

The author deals with the tradition of mental patterns in psychoanalytic institutes shaping the character of training. He discusses several patterns which in his opinion have become dysfunctional and are already in change: the family model, the patient model, the conception of training analysts as Olympians, the psychoanalytic identity as the endpoint of training and the model of the closed society. He argues for further transformation of these institutionalized patterns in order to avoid stagnation and remain future oriented. For each pattern he proposes concrete measures, which can be helpful for change.     

Psychoanalytic training institutes as cults: An example of entropy

Some psychoanalytic training institutes in this country more closely resemble religious cults than centers of learning. Institutes which foster the establishment of multiple role relationships between students and their instructors often unwittingly exploit students' dependence in a variety of ways. Further, there is also a conflict of interest between the institute's stated organizational goals and its need to survive. Consequently, there is a bias toward entropy. After a time, psychoanalytic institutes, like all systems, wind down. The purpose of this article is to alert the professional community to the potential hazards of the complicated relationships between instructors and supervisors at these institutes. Research studies suggest a tendency toward the development of a group-think environment where critical thinking and scientific analysis are subverted. Narcissistic gratification and passive acceptance of leaders' teachings prevail. The implications for the well-being of the candidates and the prospects for reform are explored.     

The coming changes in psychoanalytic education: Part I

The author presents a critical overview of the literature on psychoanalytic education, focusing on criticism regarding structural aspects of our educational institutions. He then presents arguments for the need of radical changes in the organizational structure of institutes, and focuses on the problems of the training analysis system. He proposes concrete solutions for these problems, in the form of changes both in the assignment of responsibilities for the personal analysis of candidates and in the selection and function of supervisors.     

'My capital secret': Literature and the psychoanalytic agon

Taking as my departure point Freud 's unequivocal claim in The Question of Lay Analysis that psychoanalytic education should include "the history of civilization, mythology, the psychology of religion, and the science of literature" ( Freud, 1926b, p . 246), I advocate for an integration of psychoanalysis with the arts, the humanities, and the social sciences in psychoanalytic training. Foundations in these fields are not only acceptable as preliminary to clinical training but will also provide the diverse intellectual climate that is urgently needed in psychoanalytic institutes whose discursive range is often quite narrow. To provide one example of the salutary effect of such disciplinary integration on clinical practice, I illustrate how the transformative power of literature provides compelling metaphors for the psychoanalytic encounter. Through an example drawn from within my own experience as literary critic and psychoanalyst, I describe the ways that the troubling tensions in Milton's Samson Agonistes functioned to illuminate, for me, an analysand 's 'capital secret'.     

A training analysis for psychoanalytic psychotherapists

For historical reasons, psychoanalytic psychotherapy has been regarded as a second-class treatment in comparison with psychoanalysis, and standards for training in it have lagged behind those for psychoanalysis. However, psychoanalytic psychotherapy is the treatment of choice for many healthier (or higher-level) patients who cannot receive analysis for any reason, and also for a large population of more-disturbed patients who are not appropriate for psychoanalysis. Mastering techniques of psychoanalytic psychotherapy may be as difficult as mastering those of psychoanalysis, and should require comparable theoretical training, supervision, and personal treatment. This "development lag" in the training of psychoanalytic psychotherapists has taken place for several reasons: (1) Psychoanalytic ideas first emerged in America in the context of a new movement toward an electric, but dynamic psychiatry from which psychoanalysis had to establish its separate identity. (2) Psychotherapy was associated with techniques of suggestion and manipulation from which psychoanalysis wished to separate. (3) Because psychotherapy was seen as an inferior form of therapy which required little training, institutes were slow in being established, and reluctant to require a "training analysis." It is suggested that with the full training of psychoanalytic psychotherapists, this discipline may be regarded as a profession comparable to psychoanalysis. It is further suggested that the optimal treatment for the full training of the psychoanalytic psychotherapist is psychoanalysis, and that a "training psychotherapy" is not an adequate substitute, but may provide a transitional step to resolve initial resistances and to prepare the therapist for a training analysis.     

Understanding Hope. Persons in the Process of Dying

Changes both within the profession of psychoanalysis and in society as a whole have affected our psychoanalytic training programs and presented new ethical challenges. Whereas in earlier decades training programs needed to be concerned primarily about the inviolability of the training analysis and the choice of appropriate analytic candidates, today there is little support for psychoanalysis as a treatment modality. Institutes are experiencing greater competition in attracting quality candidates and in providing them with adequate training experiences. This strain encourages institutes to operate in unethical ways to attract candidates. On the other hand, within the profession itself we are experiencing much theoretical ferment and the increasing feminization of the profession. These changes are affecting our training institutes and our ethical values in both positive and negative ways.     

On My Becoming a Psychoanalyst

I describe my experience of becoming a psychoanalyst in Germany between 1997 and 2002. The article combines my personal criticism of certain aspects of institutionalized psychoanalysis and some established procedures within psychoanalytic training, which underline the need for more evaluation and more transparency within the institutes and associations.     

The optimal structure for psychoanalytic education today: a feasible proposal?

Our psychoanalytic training system, close to a century old, has been subjected to increasing criticism, starting shortly after its creation, for failing to properly fulfill its avowed purposes. The most intense critiques have centered around the authoritarian power lodged in a self-selected training analyst elite, the inadequate development of a psychoanalytic research tradition, and the isolation of our educational structure from cognate disciplines concerned with human mental life, owing to its private and part-time nature, apart from the university with its spectrum of biological and human sciences. Efforts to reform this system, including the establishment of psychoanalytic institutes within medical school departments of psychiatry, and the further call for their autonomous placement within the university at large, with full-time students and faculty, have been only partially successful and have not become widespread. The values of the newly emerging multifaceted psychoanalytic center as the best currently achievable fundamental reform are presented.     

Does anything go? Towards a framework for the more transparent assessment of psychoanalytic competence1

It has been difficult to know what does and does not constitute competent psychoanalytic work and so equally difficult to assess when it is being practised and when it is not. This makes difficult any form of disciplined evaluation of the outcome of training, which has a series of problematic outcomes for psychoanalytic practice, psychoanalytic institutions and the relationship to allied disciplines and professions. In this paper, the author considers how far it might be possible to devise a framework for assessment of training programmes within a disciplined psychoanalytic pluralism. The aspiration is to develop a transparent framework, based on an empirically supported demonstration of analytic capacity. The framework needs to be sensitive and subtle, and to be able to withstand challenge. It needs to take cognisance of the twin facts that there is more than one way to practise psychoanalysis and that it is necessary to avoid ‘anything goes’. Drawing on an ongoing project undertaken by European IPA institutes, the author describes some of the problems colleagues have been experiencing in European institutes, because they have not had available transparent criteria for assessment. He outlines a preliminary form of a proposed method for making more transparent and supportable assessment. The author intends for this paper to inspire hope, enquiry and debate.     

Suicide prevention for psychoanalytic institutes and societies

What follows are guidelines for rescue teams dedicated to suicide prevention for psychoanalytic institutes and societies. They provide a general orientation and presuppose intensive individual and organizational training by the rescue teams. Some general notes of caution: suicide prevention is a complex, delicate effort that requires specific training, experience, knowledge, patience, and courage. It is a well-known fact that drowning persons may resist rescue efforts, thereby posing the danger of drowning the rescuer along with themselves. Similarly, expect desperate, blind resistance to your efforts, particularly when the suicidal temptation is urgent and overwhelming.     

Like a phoenix from the ashes – or “sack cloth and ashes”?:1 The reconstitution of psychoanalytic institutions in Germany since 1945 and its consequences

Abstract

Here, I attempt to formulate some thoughts about the past, present, and future of psychoanalysis and its institutions in Germany. To do this, I have employed my varied experience as a supervisor and consultant to many such psychoanalytic institutes over the past several years. Themes discussed include the history of psychoanalysis in postwar Germany, the organizational structure of German psychoanalytic institutes, and their cultures in regard to group and organizational dynamics, and political and economic aspects. Finally, I add brief thoughts about the future, taking into account recent developments relating to planned changes in laws governing psychotherapy in Germany. Further, I attempt to analyze and comment on: coming to terms with the past; how to begin after the “Zero Hour”; the form of organization of psychoanalytic institutes in Germany; missing patients and missing candidates; constructive debate and hurting people’s feelings; the lack of “detoxification” and “recycling” of the poisonous remains of psychoanalytic processes; and the future of psychoanalytic institutions in Germany. I end with an example of a typical primary task used in conducting large groups in the institutes in which I worked, and include an anonymized table listing individual interventions, their duration, and frequency. These should provide an idea of my way of working, and an overview of the dimensions of the task.     

Are You Sure It Was with a Patient? What We Talk About When We Talk About Sexual Boundary Violations

Sexual boundary violations have occurred between psychoanalysts and their patients since the beginnings of our profession. Using results from an informal survey, this paper explores the effects of sexual breaches on a psychoanalytic training community from the point of view of a graduate. The author reviews some of the literature describing the great difficulty that analytic institutes have addressing these occurrences and suggests possible reasons for this difficulty.     

Psychoanalysis and the university: a difficult relationship

A critique of present-day isolation of psychoanalytic institutes and of their lack of emphasis on research and scientific development is followed with concrete proposals for reorienting psychoanalytic education toward university settings, with the ultimate purpose of bringing together psychoanalytic theory and scientific contributions with the contemporary contributions of neurobiological science and the humanities. Efforts already under way in this direction and practical recommendations for further steps to integrate psychoanalytic education and research within university settings are outlined.     

Von den Schwierigkeiten, Analytiker zu werden

The results of a study concerning the social situation of students in psychoanalytic training in DPG institutes are presented. The study based on a questionnaire worked out at the meetings of the spokesmen of DPG candidates as a reaction to the changing external conditions. The Psychotherapist Act, the introduction of a new medical specialization and the planning of demand have put a considerable strain on the training conditions and have led to reduced numbers of applicants also because more and more competing, low cost training courses for psychotherapy have come onto the market. Data are presented concerning age, gender, marital status of students, beginning and termination of training, original profession of students, means of funding, frequency and costs of training analysis and supervision, as well as monthly income and expenses. The findings show for example that students nowadays are considerably older than they used to be (see Pohl 1974 and Pollmann 1985), the number of men in training decreased as well as the number of physicians while the number of women and psychologists increased. The frequency and the expenses for training analysis strongly increased while the income decreased. Many students therefore can no longer fund their training by their current income. In addition the assumption is confirmed that psychoanalytic training takes considerably longer than required by the law. As a consequence it seems necessary to reduce costs and duration of training in order to keep psychoanalytic training competitive and practicable for applicants. Therefore it is proposed by the authors to give credit for theory acquired elsewhere, to start treating patients at earlier stages of training, to allow group supervision on a larger scale and to bring the costs for training analysis and supervision in line with the rates paid by the health insurance companies in order to keep costs manageable. Other means of support, such as scholarships or reasonable loans are discussed. It is proposed to promote and further use the innovative and creative potential of candidates at an early stage to prompt research and development of psychoanalysis. It is imperative to promote psychoanalysis in the public so that it can defend its place in society and make its contribution to public health.     

Between the basic fault and second skin

The ideas that are commonly associated with Esther Bick, such as primal skin function, defensive second skin phenomena and adhesive identity, are traditionally seen as affiliated to the larger body of work that constitutes the Kleinian school. I shall argue, however, that Bick's thinking owes a largely communally unrecognised debt to the work of her training analyst, Michael Balint. Beginning with a discussion of Bick's early psychoanalytic formation within the British Psychoanalytic Society, her ideas will be reapproached in the light of her contemporary psychoanalytic milieu, with particular reference to Balint's notions concerning primary object-love, the basic fault and space. A brief history of the Manchester Training Centre, a short-lived but pioneering British attempt to extend psychoanalytic training beyond London, is included incidentally. Bick's early intellectual openness to diverse psychoanalytic streams will then be discussed in relation to the formation of psychoanalytic groups and their relative capacity to tolerate difference.