Yet for a practice so often pronounced defunct, analysis is showing some surprising signs of, life. What’s surprising is that the liveliest stirrings are coming not from the M.D. psychiatrists who have traditionally dominated the profession but from the humbler precincts of Ph.D.s. Spurred by the settlement of a class-action lawsuit that overthrew decades-old barriers to psychoanalytic training for nonmedical health professionals, a new wave of psychologist-analysts is taking shape around the country. In the wake of the suit, about 10 new nonmedical training centers have opened, and would-be analysts are lining up to get in. Los Angeles’s just-opened Institute of Contemporary Psychoanalysis had to turn away dozens of applicants for its inaugural class of 33–huge by the standards of analytic training, where as many as 10 candidates are considered a crowd these days. Elsewhere, the picture is similar.
With the infusion of new blood, a welcome hubbub of lectures, debates and competing ideas is being heard in the analytic marketplace again. Articles and books–many of them by women psychologists–are tumbling off the presses, and adding to the din is a provocative new journal, Psychoanalytic Dialogues, that has been airing fresh views on the relationship between doctor and patient and the psychoanalytic process itself. “As best I can tell, it’s not simply a revival of interest but an explosion,” says Jonathan Slavin, president of Division 39, the home base for analysts in the American Psychological Association (APA) and the fastest growing of the organization’s 47 divisions.
Much of the new intellectual thrust in analysis is coming from women psychologists, who make up 51 percent of the division. Alienated by Sigmund Freud’s apparent inability to fathom the female psyche, feminists have gradually returned to the psychoanalytic fold as it embraced ideas more congenial to them such as object relations, with its emphasis on interpersonal influences in development. “Analysis is an ongoing creative relationship, and women are drawn to that kind of work,” says Toni Bernay, one of the plaintiffs in the class-action suit.
Although Freud himself argued powerfully against the medicalization of analysis, for most of its history in this country it has been in the grasp of psychiatrists. Few non-M.D.s have ever been admitted to schools accredited by the American Psychoanalytic Association (known as “the American”) and then only if they got a waiver of medical requirements to do special research. But the tight control proved self-defeating; as fees rose, insurance companies balked and patients vanished.
Meanwhile, psychologists had begun forming their own institutes for analytic training. In 1985 they brought their class-action suit, charging restraint of trade under federal antitrust laws. In a momentous out-of-court settlement in 1989, the American agreed to set aside around 40 percent of its training slots for nonmedical doctorate holders, including psychologists, social workers and psychiatric nurses. It also freed up M.D. analysts to teach at the psychologists’ institutes, an important factor in attracting trainees. Last July the American voted overwhelmingly to drop the medical waiver requirement.
With the first wave of post-lawsuit trainees still completing their studies, so far the revival has been more in the realm of ideas than in actual practice. But APA officials are convinced their people will breathe fresh vitality into the field. They are hoping also that psychologists can put a nicer face on analysis. “Medical analysts learned in a more authoritarian atmosphere,” says Bryant Welch, executive director for professional practice at the APA and chief plaintiff in the lawsuit. “I think the public image of analysis has suffered terribly from the view of it as rigid. We hope psychologists can give this rich and radical treatment the warmer image it deserves.” With their instinctive nurturant tendencies, female psychologists may help to provide that image. “Women are drawn to that aspect of analysis of providing a holding environment, a kind of buffer against the world,” says Toni Bernay. They may provide a kinder, gentler analysis–and a cheaper one as well. Carole Morgan, president of the women’s section of Division 39, says some of her female colleagues indicate a willingness to accept lower fees than M.D.s–which could do a lot to warm up the analytic image.
When it comes to fees, psychologists in general are by no means self-denying–just more flexible than their medical counterparts. Many use a sliding fee scale geared to patients’ means, but the national average is around $90 to $100 a session–roughly the same as the average M.D.-analyst fee. Realistically, psychologists concede that at present fee levels, they are unlikely to restore psychoanalysis to its necessary level of four or five days a week. (Necessary, really, for the depth and continuity it affords.) Even if they do lower their prices, they will still have to buck health insurers who are moving toward limiting therapy reimbursement to 40 sessions a year.
Yet psychologists insist the battle to overthrow the M.D. monopoly has been worthwhile, if only to win them the broader analytic training they can get now. More than a therapy, psychoanalysis is a theory of personality. In the view of many psychologists and psychiatrists, it still provides the sturdiest framework for unraveling the mysteries of the psyche. “Even with patients I see in once-a-week therapy, it gives me a better handle on how they’ve come to be where they are,” says Dorothy Cantor, an APA board member. Adds Jonathan Slavin: “No other perspective can compete with the way it informs your understanding and your capacity to deal with a whole range of people.”
In the end, many psychologists may be willing to take lower fees simply because they prefer doing analysis. It engages their interest more than psychotherapy by giving them “the whole landscape,” as one M.D. analyst put it. As an explanation of human behavior, moreover, many believe its importance goes beyond the couch. For some, it has the feel of a movement, as it did for Freud’s early followers. “It’s not just a practice, but a way of looking at the world,” says Maureen Murphy, who heads the Psychoanalytic Institute of Northern California, one of the recently established non-M.D. schools. Murphy hopes some new trainees graduate to social and political agencies, where their sensibility might be felt. “One thing we talk about in meetings,” she says, “is how psychoanalysis can get into the mainstream. How do we do this? To me, the chief reason I’m interested is that psychoanalysis can have an impact on society.”
Freud would have beamed.
