An Argument for Self-Paced Psychoanalytic Learning
Traditionally in the United States, when an adult wishes to continue their education, they focus on that education primarily while putting other things on hold. For example, it is common for PhD candidates to complete their doctorate prior to buying a home or having children. This model has been superimposed onto the Psychoanalytic training tract that institutes still prioritize and advertise: an intensive training tract of 3-4 years where psychoanalytic training, supervision and analysis are focused on at the expense of most other things. I wonder, though, how we have determined to stick to this model of training despite the lack of any solid evidence that it makes for better clinicians.
In fact, I believe I have anecdotal evidence that it may make for worse clinicians. Since anecdotal evidence is the only evidence any of us have, I feel it is fair to use here. I will enthusiastically welcome any and all research done that gives evidence that the foundational non-negotiable pillars of psychoanalytic training truly do result in better clinicians. In the meantime, I will make the case—based solely on my experience of supervising clinicians and my personal experience in training—that a self-paced approach to training, supervision and analysis based on individual trust in self is better for building a strong foundation for a clinician.
First, let us investigate the rationale given in institutions for intensive psychotherapy (Psychoanalysis as defined by ABP and most institutes) paired with intensive supervision paired with an intensive interpersonal cohort experience while spending hours a week in class--- all with institutionally approved guides.
One argument is that the intensity of this type of programming amounts to a full immersion into the unconscious and conscious psychic realities that clinicians will be in contact with in their work. Essentially, this intense set up will force candidates to dig very deep into their psyche and manage very intense inter and intrapersonal situations, preparing them more for the intensity of the work. The ultimate argument is that intense emotional experiences lead us to know ourselves better and therefore lead us to be able to help our patients know themselves better.
On the face of this, there is a kernel of truth that we can all grab onto. I will be the first to admit that many of the most psychologically challenging experiences of my life have been some of the most life enhancing. At fourteen I began spending my summers participating in intensive wilderness expeditions that challenged everything I knew about myself and the world. At eighteen, after belligerently refusing to attend the school that I was destined to attend, I drove across the country to Prescott College to spend four years far away from home. I was dropped at a hotel room and two days later found myself with a large group of very vegan and very primal smelling humans preparing for another wilderness expedition. Prescott College had no dorms, so I found my roommate during the three-week wilderness orientation and we found housing together following our expedition. I feel strongly that my life and psyche were forever changed due to the intensity of this experience. I believe I am a more resilient and wiser human as a result. I believe I know myself better.
In my final year of my Bachelor’s experience, Prescott College was seriously considering adding dorms and adding a non-wilderness orientation (they have since done so). As expected, those of us who had the other, much more “intense” experience were filled with contempt for even the hint that we would change these foundational pieces of the Prescott College experience. We were righteous in our self-assessment that we were stronger and more resilient and that we would never have had the same experience otherwise.
But Prescott College understood something that, at that time, I didn’t want to understand. This intense experience was useful for me. But it was likely damaging or exclusionary to many others. It was certainly (even if unintentionally) ableist considering not everyone can accomplish a three-week intensive backpacking trip through the Arizona wilderness. It is for my own self exploration to understand why and how this intense experience was important to my growth, but I am a bit wiser now and can understand that (for many reasons) it would have been traumatic to others. And unnecessarily so. There was and is simply no evidence that the experience of moving to Arizona houseless and roommate-less and being forced to take a three-week wilderness expedition with strangers (while swimming naked together in creeks) created graduates who were more prepared to share the incredible gifts they received from their other training with the world. We clung to these “pillars” because they were meaningful for those of us who it was meaningful to. And because.... TRADITION.
In other words, we projected our own subjective experience onto invisible others and created a narrative that put us in a superior category to those who had not had our same subjective experience. And without any evidence at all, we asserted our superiority out loud within our nice little group of people who felt the same as us. In this, we completely ignored the very likely reality that even a student who was offered dorm housing and an in-town orientation could benefit from the classroom training and even go on to do great things like write published novels, start adolescent centers, initiate environmental impact campaigns that made a huge difference in a community etc.
Similarly, Psychoanalytic Institutes are not accounting for those for whom this intense experience may be traumatic. Instead, there is an attitude of “If you can’t take the heat, you’re too weak to be an analyst.” This is simply unfair and untrue. One might expect that a candidate who had a more neglectful childhood might thrive in the feeling of belonging that comes from this type of cohort intensity. They may feel truly held and contained in ways that they never were as children, leading to institutional learning to feel as a second family. But one might also imagine that for a candidate who had a psychologically dangerous family situation with narcissistic and emotionally abusive parents and siblings, the cohort intensity could induce panic. So, are we saying that one is more psychologically well or able to provide Psychoanalysis? If so, what incredible bias! If so, we are essentially saying that the candidate desperate enough for love and belonging and approval that they happily jump through the hoops and fawn to abusive leaders is more well than the one who defends against toxic power dynamics. The latter is expected to “work it through” while the former is praised and raised up.
We also must admit that the intensity one feels as an analyst is different than the intensity one feels as an analysand. Just as the intensity one feels when their parent is abusing them is different than the intensity one feels when their child is throwing a temper tantrum. A candidate who opposes and fights against abusive power dynamics is not less able to work with a patient who demonstrates a great deal of aggression. In fact, they may be more able to do so due to their unique sensitivity to power dynamics on the psyche.
Furthermore, this assumption that one must receive that intense life changing experience in psychoanalytic training ignores the reality that many candidates have already had intense inter and intrapersonal experiences and may not need this from this training tract. What of those who have had intense cohort experiences in the wilderness, or at a retreat, or in a treatment program when they were younger? They’ve done this work already— why do institutes assume they haven’t?
The second rationale that institutes give for this level of intensity is that one will build relationships that support your career and growth throughout your career. It is as if this can only happen when an intensive cohort is forced to deal with their interpersonal issues throughout their education in a “say anything” kind of way. Again, I ask for the evidence. I know that many of us have built beautiful peer relationships without sharing in this intensive cohort experience and I have heard of real group abuse that has occurred and left unaddressed in this cohort model. This typically happens to those who dare to question the group or the process or the institute or their leaders in any way. It likely happens more for historically marginalized groups (See Carter J. Carter’s piece “On Racism in Clinical Training”). In this way, Psychoanalytic training becomes a retraumatizing experience that may or may not be helpfully contained by the leaders of the institute (more often than not it is simply ignored and chalked up to “grist for the mill”). Once again, the story is that the person who this experience hurts is not well enough to be a psychoanalyst.
The other rationale that I’ve heard is that each of these pillars support the others. The idea is that doing 3-5 times a week of personal analysis at the same time as 1 time a week of supervision on top of 15 hours a week of training while concurrently treating patients is a solid and containing system. By doing all at once, it is argued, one gets not only the benefit of each of these things individually, but one gets the added benefit of each of those items in simultaneous relationship with each other. I have seen, in fact, that doing all of these at once degrades each one and I am not alone in that observation. I also believe that often, doing all of these intense activities at once amounts to an attempt to tear down the candidates sense of self and trust in self in order to make room for a full acceptance of institutional dogma.
For these reasons, this argument may be the one that I feel is the most ridiculous and harmful. This is where I will begin to tie in my own anecdotal evidence. I believe this “story” will be relatable to a great many clinicians who have trained psychoanalytically.
Every time (and I do mean every time) I begin supervision with a new clinician, and they simultaneously begin analysis and training I observe a predictable falling apart of the clinician. Immediately they start to question their own instincts in the room. They begin to come into our sessions reciting different theorists and being confused (to the point of paranoia) regarding whether they should have been more silent or if they are becoming too invested in the narrative instead of what’s below it. These clinicians are not just playfully curious—they become sure that they are failures and know absolutely nothing. They start trying techniques I’ve never suggested because they just read something about it or their analyst used it and they aren’t understanding why it could have been helpful to them and not someone else. These interventions fail miserably because they aren’t in concert with the clinician’s instincts. Because their trust in themselves is so deeply eroded that their interventions are mis attuned and disastrous. To some degree, this is inevitable in the learning process of psychoanalysis. It is the deep level of self-attack that I see that is so troubling to me and I believe it hurts clients. I believe this intensity of learning and analysis and supervision amounts to a “break them down to build them up” philosophy of clinical training. This is he approach we take with our military to be sure that service members are able to dissociate from themselves and become killing machines if necessary. This is the approach we take for religious initiation.
These new clinicians also begin to become paranoid in their own treatment. They become intensely aware of their analyst’s interventions and start wondering what and why they are doing those things. They begin to focus intensely in analysis on what the analyst thinks of them and begin to ask me if I think they are well enough to be a therapist. They self-diagnose and begin to feel strongly that their analyst doesn’t like them because they are learning how analysts often feel when dealing with each personality organization. They talk to me about how painful analysis has become and how deeply confused they are. They are unsure if what they are experiencing in their program is abuse or intensity of emotional experience.
And for a time, they become very bad clinicians. Some take my advice to step away a bit from the theory and possibly reduce the intensity of their analysis, but others dig in the way the institutes tell them to. Many of these new clinicians have stumbled upon psychoanalysis through non training analysts. This means they are also faced with the crisis of leaving their psychoanalytically oriented psychotherapy and supervision (two decisions they likely made completely on their own) to find a training analyst approved by the institute at some point. This often renews paranoia about that analyst’s affiliation with the institution, paranoia about the other candidates in their cohort that clinician sees and their loyalties therein, and a strong feeling that if they disagree with the analyst’s view of analysis there will be problems in their program. It often forces analysands to perform differently in their own analysis because they feel as if this analyst is one of the people deciding if they are well enough to do this work that they are so invested in doing. In other words, this situation creates such a high need for the narcissistic defense that it is unclear to me if good analytic work is ever truly done. These candidates begin to feel like they can’t say anything…they must say and be what will impress the training analyst.
We say this is “grist for the mill”. But is it? Isn’t the natural process of exploring and sometimes interpreting the transference intense enough without the added threat of your training program and social censure and bullying without a reliable ally? Are we sure it’s not pushing things beyond the point of usefulness into the point of having young clinicians become so disconnected from themselves that we cause more harm than good? Let us remember that an undefended psyche is a psychotic psyche and so the more healthy candidates would, by default, set up increased defenses to account for this psychologically confusing and intense experience. If we aren’t sure if it’s doing more harm than good, should we not try to find out before solidly stating that it is best?
When these clinicians take my advice and take the foot off the gas, they begin to settle back into themselves a bit and I can begin again to help them understand how to use their unique self as an instrument to help the other. They begin to trust themselves again and remember what is important—only those things that help them to be more comfortable in their chair and to provide help to their clients. Not to impress people with PhD’s who quite possibly only got to their position by “kissing the ring” and spending a lot of mommy and daddy’s money.
When they don’t take my advice to step away from the theory a bit and instead dig in deeper, they end up with client feedback that makes it evident that they took their theoretical training so seriously that they missed the opportunity to see, know and hold the client in front of them. They lose clients. Some even get scathing reviews on google.
So, if you decide you are one such person who can benefit from, feel contained by and enlivened by the intensity of the 3-4 year intensive model of Institutional training I simply urge you to explore that in analysis as much as one would ask those who feel resistant to the intensity to explore why they DO NOT feel benefitted, contained or enlivened by this training. I urge you to explore what you are seeking in that process as much as one would ask others to explore what they are avoiding in that process. And I urge you to ask yourself what you are truly getting out of it. To not do so is to blindly and unconsciously act out on some unmet infantile need. To use resources that may benefit you and your family more than psychoanalysis or psychoanalytic training without knowing why. If you cannot truly say that psychoanalysis (as opposed to psychoanalytically oriented psychotherapy) and institutional psychoanalytic training is making you a significantly better clinician or helping you to become significantly more well, then it is okay to say that you are disinterested in paying $40,000 a year for a certification program.
Because, let’s be honest, no other post graduate degree certification in Mental Health costs more than $10,000 (potential cost of a sex therapy certification). This is a CERTIFICATION—not a PhD. It is not only a huge financial cost to you, but it also requires the payment of a huge emotional fee. And the research (Freedman, 1999) simply doesn’t support the benefits of any more than 2 times a week of psychoanalytic psychotherapy for therapeutic benefits to occur—and that increase is only beneficial for the first phase of treatment. Be sure you’re getting what you paid for. Because these institutes will lure you with the subtle message that you are not as good if you don’t complete their program in their way, or that you are not as well if you don’t see an analyst 3 times a week for three years. Remember—they have no proof.
And if you find yourself deeply interested in self-paced learning and analysis and supervision and would delight in taking self-paced courses at an institute (or preferably several different institutes), I strongly encourage you to do so! There are so few options outside of the institutes for training and one should explore everything they are interested in. Just be sure you aren’t seduced in those classes by the subtle and not so subtle bait that says that you will be even better and demonstrate your capability even more if you are certified. Take your time. Trust yourself. That will make you a better clinician every day.
And if you decide to avoid the institutes altogether, I urge you to find mentors you trust to continue your learning and support throughout your career. And I urge you to feel just as capable and good as those who have graduated from a program. There are so many ways to learn and grow. It is my belief and observation that when we trust our own instincts around what we can and can’t take in and what is useful to us and not, we tend to have better lives and be better clinicians. So, it is for you that I write this. So that you have an outside voice that tells you that you are good enough if you feel comfortable in your chair and your practice is thriving. If your clients feel helped and they continue to come and talk more, you are already better than many certified analysts I’ve met ever will be. Take pride in that and keep growing in your own way. In my book, that will be good enough.