Structural Elitism and Racism in Psychoanalytic Institutes

Psychoanalysis has often been referred to as a therapy for the rich. It is accused of being elitist, inherently classist and racist.

When I stumbled on psychoanalytic thought, it was a result of having chosen a psychoanalytic supervisor for State licensure. I made the decision likely out of convenience. My therapist at the time suggested private practice and I didn’t know of any good supervisors. He suggested his wife. I justified this sloppy decision around supervision by reminding myself that I had already received tons of supervision and training in solution focused, family systems, trauma focused CBT types of models during my agency work. I rationalized that it would help me to be more well rounded to consider a psychoanalytic approach despite my inherited skepticism. In truth, it was my tendency to take the path of least resistance that led me there and kept me there when at six months I wanted to quit and find something more familiar.

But then something happened. I began to realize as I talked about cases, but also about my own life, that this was the first time I was working with a “real” therapist. Her nuanced approach to joining with me, her use of questions that forced me to consider what I was saying, her reliably relayed message that she was not concerned or afraid of my “dark” side was different than I had ever experienced. She was unimpressed by my narcissistic defense of being smart, put together, conscientious and productive. When my practice was struggling to get off the ground she asked “Would you like to learn how to keep clients in treatment longer?” To which I responded with intense resistance. I did not want to be that therapist encouraging or even coercing clients into a dependency. She asked “Is there anyone you know who would not benefit from exploring their psyche within a therapeutic relationship regularly?”

She understood that I liked to figure things out on my own so she followed my contact functioning. She didn’t teach me anything unless I asked her to and often I would prefer to go seek out the knowledge on my own and show her how smart I was that I could figure it out on my own. I admit that this led me to some mistakes and gaps in understanding psychoanalysis that I still suffer from today. I often filled in the blanks with what I believed it should be. I still remember the day that I came in after reading Lucy Holmes “Wrestling With Destiny” and said, “Okay, so the talking helps us connect the lower levels of the brain with the upper levels and the relationship rewires the attachment neuropathways to make space for new kinds of relationships. Is that why this works?”

How beautiful. How simple. I remember sitting with a fellow non-psychoanalytically trained therapist over a drink one night and making my case for how I fell in love with psychoanalysis. This simple explanation brought him to tears.

How little did I know at that time! How naive I was to believe that all psychoanalysts and all psychoanalytic thought could be understood through this lens of rewiring the brain through talking and relationship. When other therapists accused psychoanalysis of being racist and classist I would defend the theory vehemently. The Modern Analysis I was learning joined with the felt reality of my clients. We believed their truth. The Modern Analysis that I was learning treated each individual as a unique human whose unique story was to be of special interest to me. There was no gaslighting in the Modern Psychoanalysis that I was learning. There was a dictate to find a way for the financial cost of therapy to be manageable for our clients as a way to resolve resistance. In fact, I was taught how to help them to make more money so that they could afford to have better lives and also possibly pay more for treatment. There was no dictate that a client who has been traumatized or abused lay on the couch, nor any dictate that they come several times a week. There was a meeting of analyst and patient— accepting where they were at that moment.

To do this work was a challenge. Not an intellectual one, an emotional one. I began to aim for the (likely unreachable) goal of being able to treat every patient who walked into my door. My goal was to own the treatment failures as my own and not those of the patient. I took Spotnitz very seriously.

In this beautiful bubble I lived in I could simply not see the argument that psychoanalysis was classist, elitist or racist by nature. That is, until I started to attend institutions. Until I began to understand what it takes to legally call yourself a Psychoanalyst.

Structuralized Socioeconomic Inequality:

There are few Modern Psychoanalytic Institutes in the United States, but I will give them the credit that (from where I sit) they are less guilty of these crimes. This is because they lack the requirement that students receive 3-5 times a week psychoanalysis. They are satisfied with the analyst and analysand deciding collaboratively on frequency. This does make the requirement of one’s own psychoanalysis somewhat more financially achievable to all students. Even better if your analyst takes insurance. They also do not require that you have cases that meet with you 3-5 times a week, making it easier for a clinician to be paid appropriately while they are working their supervised cases.

Even still, if you are a working clinician (heaven forbid a working mother) without generational wealth or partner wealth, it will likely take 10 or more years to complete your coursework if you also wish to be a good enough parent. During the entire time, you must be in analysis and supervision to be considered a “matriculated” student. If you, at any point in that process, need to pause or stop your analysis you will be immediately removed from your matriculated status until you identify another analyst from that institute’s very small pool of approved analysts to get started with right away.

And let’s hope that the institute has enough faculty to offer the courses you need for your path… as many do not.

When I spoke to one Clinical Supervisor about this dilemma , she admitted to this as a barrier. At the time I was raising three elementary aged children, seeing over 30 patients a week and taking class every Saturday. Her response was, “Yes, when I completed my psychoanalytic education my husband provided for our family and my analysis and supervision.” Some version of this statement has been reported to me again and again. “I was able to become a psychoanalyst because I had someone financially supporting me”.

In more classical institutes, it is even worse. The expectation remains that you are in your own analysis for the entirety of your studies, but at least a large portion of that analysis must be 3-5 times a week. Typically at $200/session. Just to cover one’s analysis it will cost them $2,400 a month or $31,000/year. This is not including ones supervision which is also typically $200/session or the coursework that is often $450 or more per course. Your psychoanalytic education will likely cost you anywhere between $40,000-$50,000/year and cannot be covered by student loans. If you need to take longer to complete coursework due to being a working professional and parent, it will still cost $50,000/year because of the requirement of ongoing analysis and supervision.

As I searched for any option that could allow me to maintain my financial security and my focus on being available for my children as they grew up, I hit dead end after dead end. I found myself asking, “Do they not want people like me to be analysts?” No one questioned my clinical skill. No one questioned my work ethic. No one questioned my ability to understand the material or do the work. It seemed to me that the set up allowed for a 30 year old trust fund recipient without a family and with little clinical experience to be more able to buy their title as Psychoanalyst than a clinician with over 20 years of experience— simply because of financial limitations.

It is not as if there are not solutions to this problem. It is that the institutes are not interested in them. As I summarize this blog post, I will identify the ways that Psychoanalytic institutes might be able to change this problem.

Structural Racism

As I write this section I feel I must do some racial self identification. I am aware that I often benefit from the privilege of being identified as White within White groups. I also benefit from the privilege of being seen as “Brown” in “Brown” groups. As a descendant of Iranian immigrants whose appearance most resembles my Iranian heritage, my self-identification with race has been an ever evolving one. Ultimately, though, I believe I write from a place of white privilege and acknowledge that my focus here is primarily from the closest place of empathy this white woman has achieved on this day.

I attended a talk at an institute’s monthly community meeting recently where Tracy Morgan, host of the podcast New Books in Psychoanalysis, was presenting on structural racism in Psychoanalytic Institutes. At one point, she noted that the group was talking about racism within our individual selves, but that we continued to avoid the topic of structural issues.

I find that when folks want to talk about how to change structural racism in institutes they most want to talk about representation. While we would all agree that representation is essential to begin to address these issues head on, I felt that we were still missing the point. WHY don’t we have representation in Psychoanalytic institutes? There are reasons above and beyond the socioeconomic inequality that I listed above. While that does disproportionately impact historically marginalized groups, it would be wrong to imagine that all People of Color are suffering socioeconomically and that this is the only or even primary reason we do not have racial representation in Psychoanalytic training institutes.

Here we have a dilemma that I find institutional leadership hopes to ignore. An essential part of becoming a Psychoanalyst is to be in one’s own analysis and supervision. In this, I am in full agreement despite the reality of cost (Freud’s concept of free clinics has been woefully underutilized in my opinion to address this issue). But let us look deeper into the actual reality that this training analysis requirement creates for People of Color who are also psychoanalytic candidates.

Currently, the vast majority of psychoanalysts are White (and as I mentioned earlier, white with financial privilege). Indeed, the vast majority of the “approved” psychoanalysts are also from a generation where one was not racist because they “didn’t see color”. During this conversation with Tracy Morgan, the clinical director at that institute actually stated, in front of the group (which included Women and Men of Color), that because of his upbringing he could honestly say that when he encounters Black people he does not see them as people. While I am certainly happy that he is being honest with himself about this, I find that the fact that he completely ignored the potential impact of his statement being made in front of People of Color and was unaware that he should not ever be subjecting any group to his Anti-Racist exploration process without their prior permission to be woefully misattuned and dangerous.

Alas, these are the “approved analysts” that these candidates get to choose from. And they must stay in analysis or risk being seen as failing in their own analysis. While Modern Analysts often assume that if a treatment has failed the failure is that of the analyst, I do not see that as being the prevailing attitude in these institutes. It is far more likely that an analysand who braves saying out loud that they have been mistreated is seen as the problem. And if one speaks up, they are slowly moved to the edges and out. The message is that you must stay in this treatment with this racist White person, or try again with another White person who is likely also racist in order to become an analyst.

It is one thing for People of Color to submit themselves to racist professors… quite another thing to require them to submit themselves to the intensely personal power dynamic of an analyst who has not done their own Anti-Racist work.

For years.

There is a reason that R.S. Pepper wrote the article “Psychoanalytic Training Institutes As Cults: An Example of Entropy” (1992). Imagine that one institute gets to pick the person you bear all to weekly, the supervisor you explore cases with, and also develops and delivers all of the course material you will engage in. Imagine that this analyst is also reporting on your completion of analysis. Imagine the influence and power over one person’s psyche that an institute assumes under these conditions. Now imagine how that feels as a Person of Color who has lived in a society where their anger has been pathologized and their trauma dismissed.

Why would anyone submit themselves to that when they can feel far more empowered in another training tract (CBT, Somatic Based Treatment, EMDR etc.)?

What Can Be Done?

What causes me such sadness is that it seems that there are solutions that we simply refuse to consider out of fear of diluting our training programs.

Asynchronous Distance Coursework:

Ask any online university why they are afloat and they will tell you that offering asynchronous learning as at least a part of their coursework allows for hard working parents and those who are not raising children but still need to work to support themselves to complete a degree. These training institutes are often laughed at for being less rigorous but there is actually no evidence that this is true. During the Covid pandemic, even highly respected brick and mortar universities embraced online asynchronous learning and almost every University now offers a portion of their courses in this way. As a result, these institutes have a great deal of socioeconomic, racial and gender diversity. These students are working on papers at midnight while their children sleep. They are responding to the class discussion on their lunch breaks. They are reading their assigned texts on their morning commute. I, myself, gained my Master’s Degree online (and it was a far more rigorous education than the one I started at a local bricks and mortar university, by the way). I did so because I needed to work full time at an agency providing crisis on call in addition to daytime duties (often 50-60 hours a week) to provide for myself. I did not have generational wealth or partner wealth to support my graduate studies. So I know. I know how hard one works in these programs and how much they can gain.

Our psychoanalytic institutes are clinging to the need for coursework to be synchronous and often in person. Some even seem appalled when some of us have little to no interest in being a part of a “cohort” (even while being in a group of White folks when you are not can be very dangerous). If we so much as ask for these types of accomodations, we are thought of as wishing for less rigor. While I can understand that all programs will likely need a synchronous portion and even in-person portion of their curriculum, requiring that the entirety of ones education must be this way is outdated and exclusionary. And, there is simply no evidence that holding to this tradition is improving the quality of the analysts it produces.

This would allow working people, especially parents, to tackle their education without neglecting their other important duties— such as being good enough parents to their own children. It would also allow clinicians to complete their training more quickly, relieving the need to be in ones own analysis for decades with analysts that are “approved” by their institute. While I am a big fan of continuing my analysis throughout my career there is a point at which I would like to pick my own outside of their approval and I believe we all deserve that autonomy.

Modern Analytic Certification:

Allowing for a national Modern Analytic Certification to be offered by the American Board of Psychoanalysis that removes the requirement of 3-5 sessions a week of personal analysis and two cases at 3-5 sessions a week would both legitimize the incredibly important work done by Modern Analysts while also allowing the board to hold tight to their cherished Psychoanalytic Certification that requires this higher frequency. This would make national certification obtainable without generational or partner wealth (or without going into dangerous debt, I suppose). My suggestion would be to have two certifications: Classical Psychoanalyst and Modern Psychoanalyst. Both would require the same rigor in training, both would require supervision and personal analysis, but one would allow the supervised cases to be at a lower frequency. In fact, if they were to do so they may begin to understand just how talented we must be to treat many of our borderline and psychotic patients who require a lower frequency.

Larger Pool of Training Analysts:

When I determined that my analysis needed to be at an end with my first analyst I was left with a handful of analysts approved my my institute that I could work with. What if I had been able to choose from their list, and every other institute’s list in the country? I understand that this is controversial, but what if we were even able to choose from those with less training? I have spoken to many supervisees who have met with certified training analysts who they do not trust and do not wish to talk to. Then they find themselves a psychoanalytically oriented psychotherapist that fits their needs. The treatment begins to progress properly, but they cannot count that work as training analysis. What if we re-evaluated who can be a training analyst and how we measure their skill and ability? Again, I know that I have gotten some people very upset with this idea, but if a person is expected to sit and talk with an analyst at least weekly or maybe more and they feel deeply unsafe in that relationship, how can we truly say that we are helping them to become good analysts? I have seen very skilled young clinicians dismiss an institutional tract of learning because they want to pick their own therapist.

But even if we only allow candidates to choose from training analysts who have been approved as training analysts for another institute, ensuring that candidates can choose without much effort who they talk to seems essential to me in helping People of Color to feel safer. Especially if they feel safer having a training analyst who is not associated with their school. It can feel dangerous for historically marginalized populations of people to allow one institute to have power over so many facets of their training. Can one select a training analyst who is certified as a Psychoanalyst in Iran, for example?

Increased Flexibility with Analytic Treatment Breaks for Part Time Students:

Many of these issues can be resolved if people can engage in their institutional learning part time. But that will mean that part time students should be able to take treatment breaks without being removed from the matriculation roster. I propose that once a part time student has reached their minimum requirement of training analysis they be allowed to take a break from analytic treatment, or to find a therapist that they feel most comfortable with. There is no reason that a person who does 4 years of training analysis but has financial privilege to attend courses full time is somehow more prepared to be an analyst than a person who does 4 years of training analysis but takes 10 to complete coursework. I’m not even clear how an institute justifies that the part time student must have twice the amount of training analysis to be given the same credential.

While I am in support of Psychoanalysts continuing their analysis for their entire career, I also believe there are many reasons the way this is achieved might change. It is well known that even licenced or certified Psychoanalysts go mad or wind up with dementia. But there are other valid reasons an analysand would decide to take a break from treatment or change analysts. Wanting to experience an analyst with a different theoretical focus, hoping to do analysis with a person of a different gender or race, an analysts change in the way they provide treatment (such as a move or hours changing or insurance no longer accepted). I also believe, as a Modern Analyst, that sometimes a break from treatment leads to a return to treatment with the same provider, but the break from talking was needed to experience a different kind of relational repair. Knowing you can leave and come back is very important to some patients.

But ending an analysis or taking a break from it is often fraught with feelings of self doubt. I might argue that as analysts we should in fact all experience this process so that we have empathy for our clients when they want to leave. We should not do anything in our institutes to give the idea that the analysand and analytic candidate has done something wrong that needs to be “reviewed by the board” for doing something as natural as taking a break from treatment after many years in treatment. After nine years working with an approved training analyst I decided to take a break from that treatment. I was unable to do so without being dropped from matriculation unless the board approved. What a vulnerable time in a person’s life to be asking them for approval from a board for this very personal decision. No wonder we are accused of coercion and encouraging dependency!

Free Clinics:

Freud’s free clinics were pretty simple on the face of them. If you were training to be an analyst, you got free analysis and supervision. But you had to pay it forward. If analysts in training simply didn’t have to pay for their analysis or supervision anyone could access psychoanalytic training regardless of socioeconomic status. Why are institutes not required to have free clinics?

Scholarships and Faculty Recruitment Are Not Enough

I believe our institutes and certifying bodies are in denial. They believe that they solve these issues with $5,000 a year scholarships to a few of their candidates each year. They believe that they solve this by having one Black faculty member who likely feels that they still cannot express their anger in the institute without being pathologized. Those things will not solve these issues.

It may be that the most radical and revolutionary choice we can make as students of Psychoanalysis is to abandon the idea that one must be certified or licensed as a psychoanalyst to be considered “good enough” (Winnicott). Instead to choose our own analyst and our own supervisor. Pick the courses that interest us and refuse to follow a training tract until those institutes make the changes needed to resolve these issues. We can refer to clinicians we know are doing good work even if they don’t have the proper “credential”. We can read the writing of those who have not completed their approved training tract but we know to have something of value to say. Because as it stands, a White trust fund baby can buy his Psychoanalyst title, while a single Mother of Color can work her whole life for it and never get there.

And that’s a system I simply can’t collude with.