Wednesday, December 14, 2011

Institutionalizing Psychoanalysis

I will assume that the title of this article raises as many hackles as plaudits from our members. Much of the history of psychoanalysis has been the point-counterpoint debate between those who have attempted to make psychoanalytic theory and practice conform to the “normal” development of a medical specialty or scientific discipline and those who see psychoanalysis as sui generis, a humanistic endeavor that can only thrive if unshackled by regulation and prescription. The debate has been exacerbated by the fact that its founder can readily be enlisted on one side or the other. And you may have noticed that yoking together psychoanalysis as both specialty and discipline will also raise howls of protest from those who see the other approach as stifling the progress of psychoanalysis. For my purpose, however, I want to make the case that our Division’s efforts to support “institutionalizing psychoanalysis” serve a vital mission to support psychoanalytic psychology. Not only has the Division made an enduring commitment to this task over the years, but also we have spent handsomely to maintain that commitment. Your membership dues at work!

If you have been reading my columns over the last year, you are aware that our major psychoanalytic organizations, the American Psychoanalytic Association (APsaA), the American Academy for Dynamic Psychiatry and Psychotherapy (AAPDP), the American Association for Psychoanalytic Clinical Social Work (AAPCSW) and the Division formed a loose organization, the Psychoanalytic Consortium, over twenty years ago for the purpose of working on common interests in psychoanalytic practice, teaching, training, and research. During these years, the major work of the Consortium has been to develop a common set of standards that can be applied in any program of advanced specialization in psychoanalysis. During the first ten years, the Division did the lion’s share of the work in forging a consensus that eventually led to the development of the Accreditation Council for Psychoanalytic Education (ACPE).

The ACPE is a wholly separate organization that was established to implement the training standards developed by the Consortium and specifically to become an accrediting agency that would be able to review and approve a wide array of training programs that met the criteria outlined in the standards document. In order for this external accrediting agency to have perceived value for training programs, ACPE must eventually seek and obtain the approval of the Department of Education (DoE) to serve in this capacity.

How does this “institutionalize psychoanalysis?” If ACPE succeeds in becoming both recognized by the DoE and increasingly utilized by diverse training programs, psychoanalysts will be able to say to potential patients, colleagues, policy makers, and the public at large that psychoanalytic training is a recognized, accredited specialty of the mental health disciplines with a common set of standards that are open and transparent for review. Will it get us more money, more patients, more respect from colleagues and the public? Perhaps not. But psychoanalysis will inarguably become a recognized specialty for treatment of mental illness and emotional problems.

The Psychoanalytic Consortium was able to launch ACPE and to provide the seed money for it to get started. ACPE has in turn been active in enlisting institutes to apply for accreditation and in the process work out some of the inevitable kinks and snafus working with such a diverse constituency, from large and small psychoanalytic training programs all the way up to the mysteries of DoE bureaucracyspeak. The Consortium members are committed to provide seed money through 2012. After that, ACPE will need to become self-funding through accreditation fees. Once that happens, ACPE will finally become a fully autonomous agency and the Consortium will be able to move on to other common projects. More on that in another report.

Staying on the theme of “institutionalizing psychoanalysis,” over the last twenty years our Division leaders have also been instrumental in developing a process to certify that a psychologist meets criteria to be a psychoanalyst. The American Board of Professional Psychology (ABPP) has recognized psychoanalysis as a specialty and the American Board of Psychoanalysis in Psychology has developed rules and procedures to allow psychologists to apply for this certification following completion of psychoanalytic training (or its equivalent). The value of this certification is that it comes from an external organization (ABPP) and is not based on the kind of psychoanalytic training the person has had. The goal that ABPP has had is that all psychologists will routinely apply for an ABPP as part of their postgraduate education, in the hope that this recognition will help the early career psychologist be able to define their specialty before the public and employers.

For many reading this report, the benefits of either accreditation of their institutes (through ACPE) or certification of their psychoanalytic specialty (through ABPP) may seem remote. For many of our members, completing a formal program of psychoanalytic training is no longer a option and this loss, however important, does not interfere with their abiding commitment to psychoanalytic thought, theory, and treatment. For many of our members, applying for one more evidence of skill, one more test of ability, may also seem tedious, pointless, or both.

So it may be difficult to “close the deal” and have your full support for these core commitments of the Division. As individuals, few members of the Division will directly participate or benefit from these initiatives. Even for those that do, it may well be that little personal benefit accrues to the time and expense of seeking an ABPP and that psychoanalytic training will be good or bad regardless of ACPE oversight. It may well be that complying with ACPE requirements or meeting the expectations of an ABPP certification board can only add a burden without offering an advantage. I will concede much of this and more, yet I still want to make the case of the value of these initiatives regardless of how many in the Division actually are personally affected by them.

I propose that ACPE and the ABPP in Psychoanalysis in psychology benefit psychoanalysis as a discipline and psychoanalytic psychology as integral to the science and practice of psychology. The ACPE process, if it succeeds, will mark a major step in allowing our competing psychoanalytic organizations, theories, and diverse histories to find common ground in way undreamt of only twenty years ago. More importantly, in an era where psychoanalysis is routinely dismissed, having recognition from the government, having a common set of standards, is a major step in securing our vision of psychoanalysis as an advance specialization within the mental health disciplines.

Similarly, if we are able to establish the ABPP in Psychoanalysis in Psychology as a certification that is routine among many of our members, we will be able to present a clearer message within APA and to the public at large that our skills and training are worthy of respect and attention. Keep in mind ABPP will accept equivalent training for applicants who are able to demonstrate sufficient training otherwise (and who were otherwise unable to attend an institute due to distance, family obligations etc.).

I hope I have convinced you of the importance of ACPE and the ABPP and that these and other efforts to advance psychoanalysis as a discipline are necessary if not sufficient. Please consider learning more by going to (for ACPE) and (for ABPP). While the Division Board has strongly supported these efforts, we continue to seek other ways to advance our discipline within the American Psychological Association and more broadly within the psychoanalytic community. But that is for another report.