Kandidaten in psychotherapeutischer Ausbildung

In the context of the discussion about a reform of psychotherapeutic training in Germany the question arises, which factors influence the decision of psychologists and physicians for a particular training. 343 candidates in psychodynamic, behavioural or psychoanalytic training were asked about their motives for the training, their professional objectives in general and their satisfaction with their choice of training. The candidates' decision for a particular training was associated with personal attitudes and professional goals, with the given information about psychotherapeutic treatment within their studies and with their field of study. For the most part, the respondents are not satisfied with the quality and quantity of information on psychotherapeutic treatment within their studies. Candidates in analytic training are altogether more satisfied with their choice of training and do not plan to start an additional psychotherapeutic training as often as candidates in behavioral training. The consequences of these results in particular for the medical and psychological curricula (a more balanced representation of psychotherapeutic methods) are discussed.     

The Position of Metapsychology in the Formation of Psychoanalytic Knowledge and the Concept of “I” (Ego)

Psychoanalysis is unique in that competence in the field can be achieved only through applying the method to oneself. Different psychoanalytic schools differ in their understanding of the unconscious, about how to approach it, or how to define the specificity of the psychoanalytic interaction. Consequently, there are differences in the criteria for the definition of the ‘good-enough analysis’. There are many different opinions about how to select candidates, organise the curriculum and length of training. To define psychoanalytic talent is difficult; the uncertainty in the definition of criteria to use for selection is great; the problematic overlap between personal analysis and training is constantly present; to achieve conditions in which learning and creativity can develop is complicated by trainee, supervisor and their relationship to the Institute. Confrontations about training are often heated and divergent, as well as repetitive. Systematic studies about psychoanalytic education are very few. After a short discussion of the different concerns about selection, personal versus training analysis and the ambiguities of the supervisory situation, the author gives a review of three studies on how psychoanalytic education—as viewed by trainers and trainees—is conducted and experienced at the Swedish Psychoanalytic Institute. Training is felt to be well grounded in theory and tradition; nonetheless most do not have a sufficiently clear picture of training as a whole. Both candidates and trainers see the development of a psychoanalytic identity as the goal of training, where the competencies to be acquired are equated with important personality qualities. The candidates have a feeling of “being chosen"; they “wish to belong to a group who share an interest and fascination for psychoanalytic thinking and theory". All praise the warm and open atmosphere, and the mutual and continuous evaluations and the deep involvement of all. The surge to be rooted in an overreaching psychoanalytic ethic, the culture of gratitude within the Institute and the devotion to the task to train psychoanalytic clinicians for the future may preserve an idealised image of psychoanalysis and the fantasy that psychoanalysts are exceptional persons and give a mystifying colour to the psychoanalytic profession. This might also stand in the way of a more radical change in the traditions of training—according to the rather drastically changing climate in which psychoanalysts of the future will have to work.     

Countertransference, supervised analysis, and psychoanalytic training requirements.

Because psychoanalysts have an ever expanding appreciation for the many factors that contribute to the psychoanalytic treatment process, they no longer view themselves simply as the receiver of the patient's transferences. When patient and analyst meet in the consulting room, they bring along with them a blend of intrapsychic and external ingredients--including countertransference--that make up the analytic soup. Candidates in psychoanalytic training must contend with even more sources of indirect countertransference reactions (Racker 1968) than experienced graduate analysts, due to aspects of the training experience itself. The author contends that minimum graduation requirements for supervised analyses are one such source of indirect countertransference. Four clinical examples of control analyses demonstrate this form of indirect countertransference during the assessment, opening, middle, and termination phases. These examples are followed by implications and recommendations for didactic psychoanalytic training curricula, countertransference awareness, supervision of control cases, institute governance policies and procedures, publication of clinical material, and future research.     

Fostering the educational value of candidate evaluation

Approaches to fostering the educational value of candidate evaluation are presented, in view of the plethora of intra‐psychic challenges that combine with many other complexities of learning to work as an analyst. Four integrally interrelated practices have been found to address sensitivities inherent in candidates’ experience of training in general, and being evaluated in particular. When applied in concert, the institute's evaluative process not only becomes more considered, but also better promotes a psychoanalytic attitude and minimizes the intrusion of evaluators’ personal responses. The first is defining and employing in synergy criteria for clinical immersion based on demonstration of the development and deepening of an analytic process, as well as the development of psychoanalytic competencies. The second is mandating institute‐wide application of guidelines for assessment of progression/graduation that are clearly explicated to all candidates and faculty. The third is transparent and timely communication between candidates and their supervisors and progression advisors regarding progress essential to a sense of collaboration. Fourth the progression review process must be systematic and in‐depth, with built‐in consultative relationships serving as checks and balances on personal elements. The implementation and educational impact of these practices are considered in the case of one candidate.     

Bullying in Psychoanalytic Life: A Few Episodes,and Some Thoughts

This article explores several examples of bullying in psychoanalytic training (often candidates bullied by faculty, but at times faculty bullied by candidates, or mutual bullying among candidates) and within psychoanalytic societies. It proposes that this may happen both in homogeneous groups (where individuals seen as disloyal to the common views may be harassed) and in heterogeneous groups (where theoretical disagreements and competition may deteriorate). Interpretations outside the consulting room (and in some instances even within an analytic setting) may become a subtle form of bullying. Although many professional and political groups may exhibit subtle and rationalized forms of bullying, their impact is more powerful in psychoanalytic groups on the background of transference–countertransference feelings originating in members' personal analyses with other members. A readiness to expose and discuss such episodes is crucial if we wish to reduce their destructive influence in training and in subsequent relations among analytic colleagues.     

Psychoanalytic practice in the early postgraduate years

As a pilot investigation for a longitudinal study of psychoanalytic careers, a survey was conducted of analysts who graduated during the last fifteen years from the Columbia University Center for Psychoanalytic Training and Research. Graduates were asked to describe both their analytic practice and their interest in pursuing appointment as training and supervising analysts. The 23-item questionnaire was completed by 67 of 102 potential respondents (66%). The study identified two subgroups of graduates: those who were not certified and were not training analysts (GAs), 78% of the sample, and certified and training analysts (CAs, TAs), 22% of the sample. GAs started a mean of 1.4 new analytic cases since graduation, as compared to CAs and TAs, who started a mean of 5.4 and 8.3 new cases, respectively. CAs and TAs also saw more twice-weekly therapy cases than did GAs. Once-weekly therapy was the most commonly practiced treatment for all subgroups. Interest in becoming a TA was highest during the first five postgraduate years and was lower among non-TAs five to fifteen years after graduation. Only one of the CA respondents met current APsaA immersion criteria for training analyst appointment.     

Psychoanalytic education in the twenty-first century: a syllabus for all seasons

I am suggesting that psychoanalytic training facilities restructure their curriculum to include opposing views, in an effort to avoid the inevitable disintegration of the field at large. Without a sense of requirement for any particular viewpoint, I have suggested the model of class modules, usually based around three differing positions, be applied in as many classes as possible. This method enhances the very nature of psychoanalysis while it extends the educational provenance of each separate institute, and specifically each teacher of psychoanalysis. In so doing, candidates across the board will feel and think in a more collegial manner, and may find that learning psychoanalysis is to learn something new and exciting.     

Some hazards to neutrality in the psychoanalysis of candidates

The author looks at the challenges confronting psychoanalysts as they attempt to approach a desirable goal of neutrality in the treatment of psychoanalytic candidates and others who will become or are professional colleagues. Many such hazards are embedded in the interlocking relationships that inevitably exist between the analytic institute and its personnel, its training analysts, and its candidate-analysands. The author considers difficulties in the crucial analysis of aggression in training analyses. The analysis of aggression plays a determinative role in the personal and professional lives of analysands, and vitally affects the health and creativity of analytic institutions and the future of psychoanalysis.     

The future of psychoanalysis and its institutes.

If the function of psychoanalytic training institutes is to train practitioners of psychoanalytic technique, it is unreasonable to expect institutes to offer effective training in research or other scholarly applications of psychoanalysis. But if one insists that the training of psychoanalysts should, at least in some instances, encompass more than the teaching of psychoanalytic therapy, the training institutes have been failing in their function to educate candidates for scholarly activities. Whether the structure of the independent training institutes can permit such broadened training is questioned. One solution is to move the educational function into the university setting.     

Idea and reality of training analysis. A plea for reforms (II)

Thom? pleads for a form of psychoanalytic training in which the critical appropriation of psychoanalytic and humanistic knowledge as well as therapeutic competence are the focus and in which the personal analysis (super-therapy) is no longer overvalued. It seems possible to limit the length of training analyses. Qualification for professional practice should be worked out exclusively within the training institute and in close collaboration with instructors.     

Teaching psychodynamics in the twenty-first century

A lack of clarity in psychoanalytic education has negatively affected the educational experience of candidates now in training and makes it difficult for prospective candidates to understand the field. Three basic educational concepts--learning objectives, operationalizing, and adult learning theory--can help psychoanalysts teach and assess their students in a clearer, more objective way. Using these concepts has broad implications for both psychodynamic and psychoanalytic education in the twenty-first century.     

National Survey of Psychologists' Test Feedback Training,Supervision, and Practice: A Mixed Methods Study

In this empirical, mixed methods study, we explored test feedback training, supervision, and practice among psychologists, focusing specifically on how feedback is provided to clients and whether feedback skills are taught in graduate programs. Based on a 48.5% return rate, this national survey of clinical, counseling, and school psychologists' suggests psychologists provide test feedback to clients but inconsistently. Most respondents, 91.7%, indicated they give verbal feedback at least some of the time, whereas 35% do so every time. However, 2.8% indicated they never give feedback. A negative correlation exists for clinical psychologists between years since graduation and providing verbal feedback. Of particular interest, approximately one third of respondents indicated predoctoral coursework, practica, and internship were of little-to-no help in preparing them to provide feedback. Also, feedback training in predoctoral coursework, practica, and internship was not correlated to actually providing feedback. There was, however, a significant correlation between postdoctoral training and providing feedback. Consistent with existing ethical exceptions, the most frequent reason for not providing feedback was using assessments in forensic settings. Individuals who indicated their training was not helpful cited “trial and error” and self-instruction as ways in which they learned feedback skills. We discuss implications and suggestions for feedback training, research, and practice.     

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.     

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.     

The Search for Integration or How to Work as a Pluralist Psychoanalyst

In my professional path, I strove for the integration of my identity as a psychiatrist and as a psychoanalyst, in the frame of pluralism, which exists in modern psychoanalysis. Having been trained in a Kleinian approach, I will explore the painful breach experienced during my parallel trainings as a psychoanalyst and as a dynamic psychiatrist. I worked for five years as a psychoanalyst and a researcher in Germany and was involved to a large extent with the psychoanalytic world, which increased my self-definition as a pluralist. On my return to Chile, I discovered the need for political changes in the psychoanalytic society and curricular modifications in my training institute to recover psychoanalysis from its academic isolation. Finally, I will analyze the extant connections between the ideology of pluralism in psychoanalysis and its application in clinics. I will show that the exploration of the inference processes of the psychoanalyst inside a session—the psychoanalyst's mind at work—demonstrates that the analyst in fact functions as an artisan thinker. This means that pluralism—that is, the use of more than one theoretical frame and of different levels of abstraction and explicitness—is the way the majority of psychoanalysts “naturally” work. What probably differs is the self-consciousness, scope, and rank of pluralism.     

Decisions,actions, and the appropriateness of confidence in knowledge

This research examines the appropriateness of confidence (i.e., subjective probability judgments) in knowledge associated with decisions and actions of social importance. One hundred and thirty seven participants completed a 50 item questionnaire assessing their knowledge of the two leading candidates in the 1988 presidential election in the U.S.A. Ninety one of the respondents completed the questionnaire one week prior to the election, whereas the other 46 completed the questionnaire on election day shortly after voting. After each item in the questionnaire, all respondents indicated whether or not the item content represented a reason why they voted (or intended to vote) for or against the candidate to whom the item referred. Within-person results indicated that, in comparison to items that were not cited as reasons for voting intentions or voting behavior, items endorsed as reasons were characterized by better accuracy and resolution, but worse overconfidence. Between groups, decision makers were significantly more accurate and better calibrated than those who had not made a decision between the candidates. Implications of inappropriate confidence on decision making effectiveness are discussed.     

Ausbildungs- und Berufserfahrungen älterer Psychoanalytiker

Based on the discussion about the crisis of psychoanalysis and in particular of psychoanalytic training, 145 (female and male) analysts older than 70 years of age were interviewed about their training and professional experiences as well as about their attitudes towards psychoanalysis. This older generation is of great interest because their training generally took place prior to 1967 and preceded the introduction of guideline therapy (cost coverage by the general health insurance) and under much less formalized conditions, which can be seen almost as a contrast to the current circumstances and conditions. This research has shown that especially personal or content and value-based motivations (personal problems, therapeutic experience, interest in the subject, the desire for depth, self-realization and expansion of the situation perceived as restrictive of their former profession) were the main determining factors for the choice of career. The training analyses were, despite some exceptions, of substantial length even then (an average of 544 h), but often had a lower frequency (30% had less than 3 h per week). Since the age limitation for running a psychoanalytic practice within the general health services (formerly 68 years) is no longer compulsory, the results of this study regarding the professional life of older psychoanalysts are of special interest. Of the respondents 45% are still running their own practice and 22% are working as training analysts.     

In the Name of Psychoanalysis: Persistent Controversies and Evolution in Psychoanalysis: A Review of Impossible Training: A Relational View of Psychoanalytic Education by Emanuel Berman

In his book Impossible Training, Emanuel Berman stresses the historical roots of current standards of psychoanalytic training and demonstrates the persistence of controversies that have been present in psychoanalysis and psychoanalytic training from their inception. This perspective, of psychoanalysis and psychoanalytic education as evolving, encourages candidates and practitioners to be participants and creative voices in an evolving field rather than rote followers learning a trade. The author proposes ways that the transference of educators to the younger generation of psychoanalysts can facilitate or interfere with the training of candidates. Berman is applauded for shedding light on current controversies in psychoanalytic education by showing their roots in historical controversies. However, the author points out Berman's tendency to overvalue his side of the controversy rather than embrace controversy itself as in the best interest of the evolution and development of the field.     

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.     

CHALLENGES FACING FEMALE DOCTORAL STUDENTS AND RECENT GRADUATES

Although increasing the numbers of women and minority faculty in academia is a widely held goal, their numbers remain small. The presence of women and minorities decreases disproportionately at each ascending rung of the academic ladder. This investigation identified factors potentially contributing to attrition in White and non-White women at a critical stage in their careers: as doctoral candidates and recent graduates. Two-hundred and twenty-four women in the life sciences, social sciences, and the humanities described their most pressing professional and personal concerns and offered suggestions for changes in their fields and in academia more generally. Independent raters coded responses by thematic content. Differences in responses by field, educational status, and minority status were examined. The most frequently cited concerns involved practical issues such as finding employment, financial stability, and developing professional expertise, revealing wide-spread concerns about a competitive academic climate. Suggestions included modifications in professional conduct, the employment and pay structure, and training.