Three Problematic Assumptions about Psychoanalytic Education: A Brief Communication

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  • http://apa.sagepub.com/Association

    Psychoanalytic Journal of the American

    http://apa.sagepub.com/content/60/1/97The online version of this article can be found at:

    DOI: 10.1177/0003065111435816

    2012 60: 97J Am Psychoanal AssocP. Roose

    Otto F. Kernberg, Deborah L. Cabaniss, Elizabeth L. Auchincloss, Robert A. Glick and StevenCommunication

    Three Problematic Assumptions about Psychoanalytic Education: A Brief

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    DOI: 10.1177/0003065111435816

    Otto F. Kernberg / Deborah L. Cabaniss / 60/1Elizabeth L. Auchincloss / Robert A . Glick / Steven P. Roose

    Three ProblemaTic assumPTions abouT PsychoanalyTic educaTion: a brief communicaTion

    I n December 2010, the Committee on Institutes of the American Psychoanalytic Association conducted a routine site visit of the Columbia University Center for Psychoanalytic Training and Research. We are writing this brief communication, not to respond to that site visit, but rather to engage our psychoanalytic community in a discussion of some critical issues raised during the wrap-up session and by the written report; equally important, these issues have been debated for years by our own faculty. This brief communication represents the opinions of the authors. We do not speak for the faculty or administration of the Center, and many on the faculty at Columbia may disagree with our views and

    Otto F. Kernberg, Director, Personality Disorders Institute, New YorkPresbyterian Hospital, Westchester Division; Professor of Psychiatry, Weill Cornell Medical College; Training and Supervising Analyst, Columbia University Center for Psychoanalytic Training and Research. Deborah L. Cabaniss, Clinical Professor of Psychiatry and Director of Psychotherapy Training, Columbia University Department of Psychiatry; Training and Supervising Analyst, Columbia University Center for Psychoanalytic Training and Research. Elizabeth L. Auchincloss, Professor of Clinical Psychiatry and Vice-Chair, Graduate Medical Education, Weill Cornell Medical College; Training and Supervising Analyst, Columbia University Center for Psychoanalytic Training and Research. Robert A. Glick, Professor of Clinical Psychiatry, Columbia University; former Director and Training and Supervising Analyst, Columbia University Center for Psychoanalytic Training and Research. Steven P. Roose, Professor of Clinical Psychiatry, Columbia University; Chair, Research Committee, Columbia University Center for Psychoanalytic Training and Research; Research Psychiatrist, New York State Psychiatric Institute.

    Submitted for publication October 27, 2011.

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    O t t o F. K e r n b e r g e t a l .

    may have interpreted the site visit report differently. We present our reac-tions and hope this will stimulate further discussion.

    The site visit raised three concerns that we believe are based on prob-lematic assumptions about psychoanalysis and psychoanalytic training that are damaging to progress and innovation in psychoanalytic education and our field. These relate to (1) comprehensive clinical diagnosis when evaluating patients for psychoanalysis and the influence of empirical psychoanalytic research; (2) the duration of psychoanalytic training; and (3) the professional practices of our graduates.

    comPrehensive clinical diagnoses and The influence of emPirical

    PsychoanalyTic research

    In the written report and during the wrap-up session, the site visitors brought up the issue of whether or not the necessity for a complete cat-egorical diagnostic assessment [which is required at Columbia for training cases] might color or influence the evaluation process as well as the can-didates ability to listen and think analytically as they were getting to know their patients and the degree to which the candidates training experiences are overly influenced by a descriptive perspective, resulting in more superficial analytic processes.

    We believe these comments reflect a long-held but unsubstanti-ated assumption that clinical phenomenological diagnosis (here called the descriptive perspective) promotes superficiality. There is no evidence that this is true. We feel that this assumption is simply a bias of some analysts. The data we do have (Caligor et al. 2009) indicate that lack of rigorous diagnosis in psychoanalytic evaluations fre-quently leads psychoanalytic candidates to miss clinically significant mood, anxiety, and substance abuse disorders in their patients, thus compromising patient care. We believe that phenomenological diag-nosis is necessary to treat patients. Psychoanalysis is a treatment and, as such, making a phenomenological diagnosis is an essential part of evaluating a patient for psychoanalysis.

    In addition, the site visitors and some of our faculty share a concern about the influence of empirical research on the training of candidates: The fact that the Columbia Center is located in a Department of Psychiatry with strong research interest has raised questions in the past, both in prior site visitors and in the Center itself, about the degree to

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    THREE PROBLEMATIC ASSUMPTIONS

    which the candidates training experiences are overly influenced by a descriptive perspective, resulting in more superficial analytic processes. We feel that this comment reflects an equally unsubstantiated bias that empirical research will somehow preclude learning and practicing deeper treatments. Again, this is an assumption that not only is untested but, if representative of the organization (and field) at large, is potentially stultifying for the progress of psychoanalytic education and research, and for the reputation of our field.

    lengTh of Training

    In commenting on the clinical immersion of candidates, the site visitors raised a concern about the length of psychoanalytic training: We feel that the early immersion required to progress from year to year in training [at Columbia], while fostering clinical involvement and making the seminars germane, also should be continued to be studied. We wondered if this practice could force some candidates to move along too fast or to graduate too soon. Here are the facts about the training at Columbia for the last nine graduating classes:

    mean length of training = 5.7 years (SD 1)mean number of graduates per year = 5.1 (SD 1.7)mean clinical immersion = 98.3 months (SD 20.3)mean number of cases started in training = 4.7 (SD 1.3)mean length of training analysis (of those completed, some still ongoing) = 6.7

    years (SD 2.1)

    Since the American Psychoanalytic Association does not have data about these training parameters at other institutes, it is impossible to know whether Columbia candidates graduate faster or slower than candi-dates at other institutes.

    In our view, it is best not to advocate for either fast or slow graduation. At Columbia, we have well-described educational objectives for our psychoanalytic training program that include participation in classes, a certain minimum amount of clinical immersion, and satisfac-tory work with psychoanalytic patients as documented in semiannual supervisory reports. When our candidates achieve these objectives, they are ready to graduate. Our aim is neither to overvalue nor to fear gradu-ation. Indeed, our studies (Cherry et al. 2004; Cherry, Wininger, and Roose 2009) show that although graduation has significant pragmatic values for our candidates, it is not the end of psychoanalytic education.

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    O t t o F. K e r n b e r g e t a l .

    On the contrary, our graduates continue in supervision, join study groups, and demonstrate an ongoing commitment to their training cases (Glick et al. 1996). When it comes to length of training, we feel that the equation of longer with better is an extremely problematicand unsubstantiatedassumption that often has detrimental effects on candi-dates, institutes, and the field at large.

    PosTgraduaTe PracTice of Psychoanalysis

    Finally, there was a discussion between some faculty and site visitors in which they shared their concerns about the psychoanalytic practice of our graduates. This led to the following comment: The question arose as to whether or not the drop of an analytic practice after graduation that has been noted in a number of graduates might be related to an overvaluation of their description of surface variables (although another explanation for this outcome could be that the Columbia Center is more able than other institutes to attract candidates who are on trajectories other than develop-ment of full-time private practices). As with length of training, innova-tive research means we do in fact know what our candidates do after they graduate (Cherry et al. 2004; Cherry, Wininger, and Roose 2009). However, because there is so little data about this issue from other insti-tutes around the country, it is impossible for anyone to know whether Columbia graduates practice less analysis after graduation than graduates of other institutes, let alone to speculate why this might be the case. The data that do exist (from the Cincinnati Institute and the New Center for Psychoanalysis in Los Angeles), collected in collaboration with our research group, show that the analytic practices of our graduates mirror those of graduates of at least two other institutes (Pretsky, Aizaga, and Cherry 2009; Kaplan et al. 2009).

    In the past, the received wisdom was that graduates with many psy-choanalytic cases were strongly identified with the field, while those with few psychoanalytic cases were disgruntled and disaffected. What the Cherry study indicates is that Columbia graduates follow two trajectories, with one group starting more new cases after graduation and maintaining an overall greater immersion in psychoanalytic practice than the other. The graduates with many cases are interested in maintaining the immer-sion required to become training analysts, while those with fewer cases are pursuing careers in every aspect of the mental health field, including administration, teaching, and research. However, the graduates in both

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    groups report being connected to and excited about psychoanalysis, and feeling that psychoanalytic training has enriched their careers. We believe that our graduates who are engaged in teaching and scientific investiga-tion are particularly vital to the future of psychoanalysis, as they bring psychoanalytic thinking and questions to cutting-edge research and to generations of trainees. We feel strongly that having both groups of graduates enriches both the Center and our field more generally. The assumption that the only truly affiliated graduate is one who spends all day analyzing patients in private practice is the third problematic assump-tion that we think our field needs to revisit.

    concluding remarks

    We decided to write this brief paper because we feel that our field needs to address the assumptions and biases that permeate how many in our field evaluate psychoanalytic education and career development. In our view, the opinions we challenge are damaging to the progress of psycho-analytic education and the field at large. We are eager to engage our col-leagues in this discussion because we believe there is an urgent need to effect substantial change in the way we design, implement, and evaluate psychoanalytic education. We feel strongly that this dialogue must be informed by multicenter empirical and observational data. Without this, we will continue to propagate assumptions that are at best untested and that at worst impede the progress of psychoanalysis and psychoanalytic research. We look forward to reactions to these comments.

    RefeRences

    Caligor, E., StErn, B., Hamilton, m., maCCornaCk, V., WiningEr, l., & rooSE, S.P. (2009). Why we recommend analytic treatment for some patients and not for others. Journal of the American Psychoanalytic Association 57:677694.

    CHErry, S., CaBaniSS, D., ForanD, n., & rooSE, S.P. (2004). The impact of graduation from psychoanalytic training. Journal of the American Psychoanalytic Association 52:839849.

    CHErry, S., WiningEr, l., & rooSE, S.P. (2009). A prospective study of career development and analytic practice: The first five years. Journal of the American Psychoanalytic Association 57:703720.

    gliCk, r.a., EaglE, P.F., luBEr, B.m., & rooSE, S.P. (1996). The fate of training cases. International Journal of Psychoanalysis 77:803-812.

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    O t t o F. K e r n b e r g e t a l .

    kaPlan, m., PrEtSky, J., WiningEr, l., rooSE, S.P., & CHErry, S. (2009). A profile of analytic practice across the country: Immersion data for three institutes (poster summary). Journal of the American Psychoanalytic Association 57:11791173.

    PrEtSky, J., aizaga, k., & CHErry, S. (2009). Analytic practice patterns among psychoanalytic institute graduates: A bicoastal comparison (poster summary). Journal of the American Psychoanalytic Association 57:440451.

    Steven P. RooseDepartment of PsychiatryColumbia University1051 Riverside DriveNew York, NY 10032E-mail: spr2@columbia.edu

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