As Op Editor of InternationalPsychoanalysis.net I am pleased to post a new editorial from Jennifer Harper about a current debate in the United States on a recent licensing bill passed by several states due to the effort of the National Association for the Advancement of Psychoanalysis (NAAP). More than an opinion piece, Jennifer Harper has given a history and explanation of NAAP’s efforts to protect psychoanalysis. Although this piece was written in response to my recent editorial, I feel that its depth and breadth merits its own editorial space. Your responses are welcome.
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An editorial by Jennifer R. Harper, MDiv
Past-President, NAAP
Chair, Psychoanalytic Recognition Committee, NAAP
Many thanks to Jane S. Hall for her editorial of August 7, 2007 and for her thoughtful outline of qualities that make good analysts. I applaud her effort to initiate an on-line conversation around a number of issues that have aroused consternation among various psychoanalytic groups and individuals over the meaning of the term psychoanalysis and of the requirements for training that are reflected in the New York state license.
The license we have in New York state is a product of many defensive maneuvers carried out over a period of more than 30 years on behalf of evolving groups, including various subgroups of existing mental health interests and more recently of the legislative efforts and organization of the National Association for the Advancement of Psychoanalysis (NAAP).
Contrary to the perception that NAAP has aggressively pursued licensing for psychoanalysis, NAAP has in fact aggressively defended lay analysis against multiple attempts by the existing mental health professions (medicine, later psychology and more recently social work) who seek to own and control the scope of practice of psychoanalysis within their own licenses; thereby denying the existence of independently trained psychoanalysts. Even in this history of struggle there are efforts that we can all support and join around as we seek ways of cooperating more clearly among ourselves around our common interests and our continued differences — as psychoanalysts and psychoanalytic organizations.
Founded in 1972, NAAP was organized as the first ecumenical group of psychoanalyst members who gathered to form an association with the mission to promote psychoanalysis as an independent profession from mental health professions.
Since Freud’s treatise On the Question of Lay Analysis (1926), psychoanalysis has been articulated as separate and distinct from other professional backgrounds; a unique practice with its own particular requirements for training. In addition, Freud himself gave us a meaningful definition of the process and practice of psychoanalysis: about transference and resistance, Freud (1914) writes, “[a]ny line of investigation which recognizes these two facts and takes them as the starting point of its work has a right to call itself psychoanalysis, even though it arrives at results other than my own.” (p.73, On the History of the Psychoanalytic Movement S.E., 15: 59-127. Penguin Books, 1993) If we take Freud seriously here, we are all cautioned against defining psychoanalysis by our own convictions.
In this ecumenical spirit, NAAP also sought to promote the existence of various psychoanalytic orientations that had emerged in time with the evolution of psychoanalytic thought since Freud (Adlerian Analysis, Jungian Analysis, Existential Analysis, Object Relations Theory, Self Psychology, Ego Psychology, Relational Psychoanalysis, and Modern Psychoanalysis, to name some). Members of NAAP are representative of a broad spectrum of the licensed mental health professions, as well as analysts who represent what Freud called lay psychoanalysis, or non-medically trained psychoanalysts. Even in our diversity, as shown by the variety of mental health backgrounds and other professions that are represented within NAAP; NAAP members share a common vision: that psychoanalysis can not be owned or claimed by the oversight of other professions.
With this mission and vision NAAP has contributed significantly to the field by preserving the independence of psychoanalysis. Without NAAP’s efforts, psychoanalysis would likely have been limited long ago to practice within the scopes of medical and more recently psychology licenses. Freud himself would have admonished against this outcome. (On the Question of Lay Analysis, 1926) It is not a question of professional bias, it is a question of freedom for psychoanalysis itself. Much of what is happening in Europe now reflects this earlier American trend, ironically in countries where lay analysis has been the normative practice since its beginnings in Vienna. All this struggle – beyond our own skirmishes in New York — evidences something much deeper and more troubling that threatens the freedom upon which psychoanalysis depends in order to flourish. Possession, kills.
With the advent of licensing for psychoanalysis in New York state, a group of psychoanalytic organizations and Institutes who were opposed to the new licensing regulations formed a confederation (NYSPAC) and sued the State Department of Education and the Office of the Professions claiming they failed to promulgate regulations in accordance with the legislative mandates and statutes.
Frederic Perlman, a member of IPS, states in the International Psychoanalytic Society Newsletter, Winter-Spring 2004, that the New York law specifies that “coursework in a psychoanalytic institute shall be comparable to that required for a master’s degree.” This statement is misleading. Section 52.35. Psychoanalysis, of the education regulations, states that “[i]n order to be admitted into the program, the program shall require the student to have completed a master’s or higher degree program in any field registered by the department pursuant to this Part,…” A master’s degree in any field is required prior to beginning psychoanalytic training. The regulations continue to articulate that a “course of study shall include coursework substantially equivalent to coursework required in a master’s degree program in a health or mental health field of study.” (Section 52.35. Psychanalysis) “This compromise was worked out with representatives for the New York State Medical Society when it was pointed out to them that in lieu of a mental health background [prior to entering psychoanalytic training programs], courses included in the beginning years of psychoanalytic training in a state chartered institute are equivalent to course work required for a master’s degree in mental health.” (Pearl Appel, NAAP News, Summer 2004) This compromise was made to ensure that within psychoanalytic training programs, a master’s level degree equivalency in mental health training would be taught during the first years. This was done precisely to acknowledge the importance of this background for training in psychoanalysis.
While it may seem like a small point to labor, it is not. It is a point that has been misunderstood and misrepresented in much of the upset and discourse throughout our communities over the meaning and implications of the new license and its requirements. Detractors have continued to assert that the new license reduces the standards of psychoanalytic education to those of an entry level profession. Not true. By definition, psychoanalytic training continues to be a post-master’s training, pursuable by the practitioner independently of other professions, as it has been for many years now in the United States. In addition, the education requirements of the new license define the need for a master’s equivalency of training in mental health to be included in the curricula of training institutes during the first years of psychoanalytic training. The ongoing misunderstanding and misrepresentation of this requirement in the New York state license, education regulations for psychoanalysis, is easily corrected by a clear reading of the law and of the regulations.
The NYSPAC lawsuit contends that the Education Department promulgated regulations for standards in psychoanalysis that are lower than generally held standards by other psychoanalytic organizations. On this point it is important for us all to be clear about the aims of the State as separate from the aims of a profession. The Department of Education has an obligation toward and an interest in protecting the public. Public protection is provided by all professional licensing and is regularly established at levels determined to be minimum requirements for training within the profession achieving a license. Professions, on the other hand, have a great deal of interest in establishing standards that facilitate freedom to elevate and distinguish practitioners from within their determined ranks for achievement and prestige. Minimum requirements and standards are similar ideas but different realities when viewed from the vantage of State regulation.
As a profession we should be cautioned against involving the State beyond establishing minimum requirements and into the arena of standard setting. The free-market for setting standards is best exercised within the ranks of the profession itself — not by bureaucrats who don’t practice or train in the profession. Their presence is to establish minimum requirements for the preparation of practitioners to safely assure that the public is guarded from harm by untrained persons. Ironically, the freedom to set standards among the various psychoanalytic groups and associations, far from being compromised, continues to exist.
Perhaps the most contentious issue in the debate over standards and State minimum requirements has focused on the issue of session frequency. Frequency, while not defining of psychoanalysis, is an issue of serious concern within the ranks for setting standards in psychoanalytic training. Here again, we are free to set standards according to the philosophies and theoretical orientations espoused by the particular training institutes. For the purpose of setting State regulations it was determined best to allow the institutes to articulate the frequency standard… within their own training communities.
In a meeting with David Hamilton and others from the OP, the issue of session frequency came up. Our discussion focused on the variety of orientations (Freudian, Jungian, Adlerian, Modern, Relational, etc.) that exist throughout our professional diversity. The philosophies of these various orientations have determined different standards for session frequency through time, e.g., Freudian 4-5x a week (interestingly not by Freud, but by his followers), Jungians 2x a week (not by Jung, but his followers), Adlerian analysis is customarily conducted once a week because Adler did this. Modern Freudians (as in Spotnitz, et.al.) practice once a week because Spotnitz practices this way (incidentally this is not inflexible) and so on. The decision not to articulate frequency in the state minimum education requirements was made precisely to avoid interfering with the freedom of the orientations and philosophies of training that exist. It was not left out in an effort to demean or diminish the standards of any psychoanalytic group or organization.
New York state requirements for psychoanalytic education are set at minimums, or not set, in order to preserve the freedom of training institutes to adhere to their own philosophical and theoretical orientations — as can best be done in the face of government regulation. They are minimums – meant for public protection alone, not professional enhancement. It is helpful to remember that medical licenses alone carry a minimum prestige within the profession of medicine. Many more standards of measure and accomplishment (diplomates, publishing, etc.) beyond licensing build the prestige of a profession and its practitioner.
In response to the NYSPAC lawsuit, the State had only to demonstrate to the court that in good faith they articulated minimum requirements of training for the safe practice of a profession and to show their reasonable efforts to adequately protect the public from untrained practitioners. The lawsuit was lost on these points and also because the plaintiff (NYSPAC) was unable to show injury (economic damages) to their parties (group members) by the regulations that were set forth.
The license that exists in New York state is a result of ongoing efforts by professions who attempted to possess the right to practice psychoanalysis to the exclusion of others. First, the medical community tried to control the scope of practice. Through efforts to resist this, the psychologists were given a certification and later a license in New York state. Following this psychologists began to assert that practicing psychoanalysis without a medical license or psychological certification was unacceptable. The New York license is the outcome of a tug-of-war over repeated efforts by licensed professions to control and establish the practice of psychoanalysis within their respective scopes of practice and repeated efforts by NAAP to defend against these attempts. NAAP’s aim is simple: to defend against the ownership of psychoanalysis by any one of the mental health disciplines.
In contrast to the assertions that the New York license has diminished the standards of our profession, I would suggest that it has articulated a respectable minimum level of requirements for educating psychoanalysts and wisely left the issue of frequency and other standards to be debated freely among the various groups who wish to set their own standards for training and practice. This freedom to argue and debate these standards within our profession – what they should be, and how they should be – is precisely the freedom that cultivates growth, creativity and diversity within psychoanalysis. And reminds us, too, that even in the muddle of it all, psychoanalysis is still very alive…
Jennifer R. Harper, MDiv
Past-President, NAAP
Chair, Psychoanalytic Recognition Committee, NAAP