Developing Psychoanalytic Cases and the Candidates Who Will Analyze Them: an Educational Initiative

Abstract

An educational initiative, Psychoanalytic Case Development Supervision, began as an ad hoc practical response when nearly half the candidates in a talented class lacked the psychoanalytic case required for progression. All incoming candidates were assigned a supervisor with whom to meet weekly to consider clinic applicants and patients in their psychotherapy practices for analysis. Gradually it has become clear that readying candidates, in highly individualized ways, to engage in intensive work is as important as developing patients. Not only has this program yielded beneficial results for progression; it has also contributed to a subtle paradigm shift in pedagogy centering on two contemporary controversies: objective assessment of analyzability vs. subjectivity in recommending analysis, and the value of a categorical distinction, based on frequency of sessions and use of the couch, between psychoanalysis and psychoanalytically oriented psychotherapy. A four-year process of discovery-drawing on interviews with forty-nine participants (educators, supervisors, candidates)-is contextualized within the literature on these controversies. Participants' reflections are discussed, as are other features of the program and future directions for this work in progress.

A National Survey of Candidates

“…One hundred patients applying for analytic treatment were systematically assessed and showed no significant differences in psychopathology between those accepted and those rejected for analysis (Caligor et al 2009). This supports the idea that supervisors should broaden consideration of all cases in candidates' practices as potential analytic cases or consider a trial of analysis (Rothstein 1998). Recent literature suggests also that converting cases from candidates' psychotherapy practices has significant advantages over starting analytic work with new patients or with patients referred from psychoanalytic clinics.…”

“…Recent literature provides some answers. A unique educational initiative involving both supervisory and curricular interventions affirms the importance of helping candidates deepen their work with patients from the very beginning of training (Rothstein 2010). This program involves supervisors and teachers working actively with candidates, often in very individualized ways, to help ready them for analytic work.…”

A National Survey of Candidates

“…Candidates in this study express frustration and demoralization when they are unable to find or develop analytic cases, a problem that contributes to difficulty graduating. To deal with this problem, educational innovations have been established in some institutes to help candidates ready themselves for intensive analytic work (Rothstein 2010). Since a significant number of candidates do not have active psychoanalytic practices after graduation (Cherry et al 2004), we believe that psychoanalysis should broaden the scope of its training to make it relevant to the large group of trainees who perceive that their formal graduate or postgraduate training has not provided them the psychotherapeutic skills they need, who want to work more intensively with patients, and who are interested in a psychoanalytic framework for a variety of clinical, educational, and research pursuits.…”

The Effect of Frequency and Duration on Psychoanalytic Outcome: A Moment in Time

“…I view frequency and duration in the context of determining the optimal psychoanalytic treatment, rather than defining characteristics of the process itself. From this perspective psychoanalysis is seen along a continuum (Rothstein, Arden, 2010), and rather than making a distinction between psychoanalysis and psychoanalytic psychotherapy, which is characteristic for psychoanalytic outcome research, I will refer to more intense and less intense forms of psychoanalysis. 2 ‗More intense' refers to a frequency of 3-5 times per week and a duration that is open-ended and measured in years.…”