psychoanalysis in the university: a full-time vision

Psychoanalysis in the university: A full-time vision1

Robert S. Wallerstein

290 Beach Road, Belvedere, CA 94920, USA – [email protected];

[email protected]

Psychoanalysis may be unique among scholarly disciplines and professions in hav-ing grown as an educational enterprise in a private part-time setting, outside theuniversity. Freud would have liked it to be otherwise, but in Central Europe, whenit was created, university placement was not possible. In America, after WorldWar II, the concept of the medical school department of psychiatry psychoanalyticinstitute was established in some psychoanalytic training centers but it could onlypartly overcome the educational and research inadequacies of traditional psycho-analytic training. The possibilities for a true university-based full-time trainingstructure are explored.

Keywords: autonomous university psychoanalytic institutes, department of psychiatrypsychoanalytic institutes, part-time, private psychoanalytic institutes

Psychoanalysis may be unique among scholarly disciplines and professionsin having been born, and having grown, as a developing educational andtraining enterprise, in a private part-time setting, outside the university, thatinstitution created by society as the proper vehicle for the enduring trans-mission of our collective societal knowledge, and for the creation of the newknowledge by which the scientific and humanistic disciplines amplify andenlarge their established knowledge bases. It is the university which WalterLippmann (1966) called: ‘‘the ancient and universal company of scholars’’.

Because, in the more than a century now of its existence, psychoanalysishas not yet been able to establish itself as a properly full-time academic andeducational discipline within the university structure – despite its intellectualclaims that would warrant such presence, and the intellectual advantagesthat would accrue from it – I published an article in 2007 on The optimalstructure for psychoanalytic education today, in which I outlined an eight-pronged transformation of our current part-time training edifice, the auton-omous independent psychoanalytic institute, into a psychoanalytic centerstructure, in order to approximate as closely as is currently feasible the mul-tiple inherent advantages of full-time university embedding. I indicated thereseveral American psychoanalytic institutes2 already so transformed into this

1Presented originally in briefer form at a symposium on the future of psychoanalysis and the universityheld in the fall of 2007 in conjunction with the Psychoanalytic Studies Program at Emory University,Atlanta, Georgia.2Because of my much closer knowledge of the administrative ⁄ structural arrangements of the Americanpsychoanalytic organizations, most of my examples there, and in this article as well, are drawn from myprofessional lifetime work within the United States. But from what I have learned in my many years oforganizational involvement in the International Psychoanalytical Association, I feel that these sameissues are equally relevant world-wide, though more starkly evident, and more central both topsychoanalytic discourse and to current remedial effort, here in America.

Int J Psychoanal (2009) 90:1107–1121 doi: 10.1111/j.1745-8315.2009.00195.x

ª 2009 Institute of PsychoanalysisPublished by Blackwell Publishing, 9600 Garsington Road, Oxford, OX4 2DQ, UK and350 Main Street, Malden, MA 02148, USA on behalf of the Institute of Psychoanalysis

center structure, or in the process of doing so, plus indicating some of theinherent impediments to, or ultimate limitations of, such efforts.

It should be clear to all readers of that article that I regarded my proposalthere as the best possible approximation available presently – both in termsof the inner dynamics of our current organizational structure and our con-flicted ideological preferences, and in our outer relationships at this timewithin our wider social and cultural context – to that more ideal state whichLippmann portrayed for us of the place for the best transmission of humanknowledge and for its best continuing growth, the university. This article isintended as a more future-oriented, ‘utopian’ statement of where I feelpsychoanalysis is (should be) ultimately headed, and where I feel it can(should) finally arrive.

And actually this university placement is a direction to which SigmundFreud, our founding genius, who almost single-handedly brought this newdiscipline into being, also aspired in his own visionary statements. His fewpieces about psychoanalytic education indicate these wishful longings. Hisfullest statement of his own ideal structure for psychoanalytic education wasset forth only in the latter part of his professional lifetime in The Questionof Lay Analysis (Freud, 1926), and then in the context of his spiriteddefense of the psychoanalytic bona fides and impressive credentials of afavorite non-medical adherent, Theodor Reik. In that monograph he ven-tured his ideal prescription for training in the new discipline of psycho-analysis as follows:

If – which may sound fantastic today – one had to found a college of psycho-analysis, much would have to be taught in it which is also taught by the medicalfaculty: alongside of depth–psychology, which would always remain the principalsubject, there would be an introduction to biology, as much as possible of thescience of sexual life, and familiarity with the symptomatology of psychiatry. Onthe other hand, analytic instruction would include branches of knowledge which areremote from medicine, and which the doctor does not come across in his practice:the history of civilization, mythology, the psychology of religion and the science ofliterature. Unless he is well at home in these subjects, an analyst can make nothingof a large amount of his material. By way of compensation, the great mass of whatis taught in medical schools is of no use to him for his purposes.

(Freud, 1926, p. 246, italics mine)

A few pages further on, Freud stated this university-like conception evenmore tersely:

A scheme of training for analysts has still to be created. It must include elementsfrom the mental sciences, from psychology, the history of civilization and sociology,as well as from anatomy, biology, and the study of evolution.

(p. 252, italics mine)

Embedded in these statements is Freud’s implicit acknowledgement of theinsufficiency of the already established part-time and private practicepsychoanalytic institute structure created originally just a half decade earlierby Max Eitingon and his colleagues, first in Berlin in 1920, and by the time ofFreud’s writing, already spreading across the Central European heartland –

1108 R. S. Wallerstein

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Freud’s acknowledgement evident in the 1926 quotation: ‘‘A scheme of train-ing for analysts has still to be created.’’

Clearly, Freud’s stated ideal can be realized fully only within the academicuniversity structure. As presented by Freud, it seems distinctly a call for thecreation of a full-time (postgraduate) psychoanalytic training institute –full-time would be necessary if Freud’s programmatic message were to befulfilled – to which psychiatric physicians and other properly qualified indi-viduals would come for education and training into this new discipline andidentity of clinical psychoanalysis. But nothing in it specifies Freud’s visionof the particular relationship of the analytic training enterprise to the exist-ing medical school structure, or to the cognate disciplines of human mentalactivity within the university at large. But altogether, without explicit refer-ence to the university, Freud’s 1926 statements are clearly a plea for theoptimal academic placement of this new discipline.

But, at least in its historic beginnings and their sociocultural context,there could not be such a university home for psychoanalysis. This had todo, in part, with the revulsion of organized medicine and of organized aca-demia, against the scandalous childhood sexual doctrines expounded by thisnew psychoanalysis in a Victorian world, and, in part, with the almost offi-cial anti-Semitism of the Austro-Hungarian Empire that denied Freud andhis new ‘Jewish science’ the official posts and the academic recognition towhich he lifelong aspired, and in which he was lifelong disappointed.

And so, the psychoanalysis innovated by Freud grew privately from clini-cal experiences with the so-called hysterical patients, patients usually foundin those days in the private offices of neurologists, where grand hysteria wasthe prototypical illness, and the salient diagnostic distinction was betweenmultiple sclerosis, which was neurologically based, and the psychologicallybased hysterical disorders of the motor and the sensory apparatuses. Andsome two decades after the turn of the century fashioning, by the blockedacademician and emerging clinician, young Freud, of the clinical methods ofpsychoanalytic treatment, there emerged a structure for the education of thepractitioners of this new discipline, first, as already stated, in Berlin in 1920,under the aegis of Max Eitingon and others of that early generation ofpsychoanalytic practitioners. This was the concept and the structure of theprivately organized, and part-time, independent psychoanalytic institute,with its tripartite organization, of the training analysis, of clinical andtheoretical seminars, and of supervised beginning psychoanalytic practice.This is customarily financed from the earnings of the students in theirfull-time clinical careers, either within clinical mental health institutions orprivately based, and the teachers are reimbursed directly by the candidatesfor their training analyses and their supervision hours, with the classroomteaching usually a volunteer activity on the part of the faculty.

Though this psychoanalytic educational enterprise, which soon came to bequite universally accepted as the standard educational structure of theexpanding psychoanalytic world, had many evident deficiencies in doingwhat it was designed to do – and this has been made increasingly manifestin the widening chorus of complaints over recent years, with loud calls formajor reforms which have actually been too little implemented – and also,

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even, at its very best, with many limitations in relation to the benefits thatfull university placement could engender, it has had for both the teachingbody and the student body some significant advantages. For the faculty ithas meant a cherished total independence, no fear of non-psychoanalyticinterference, or demand for accommodation to the requirements of a larger,more encompassing, institutional structure. And the faculty livelihoods havebeen only in part dependent on the analytic and supervision fees of theirstudent body. And the students have been free to earn their livelihoods intheir full-time clinical activities, enough to cover both their living costs andtheir training costs, since only a portion of their time has to be devoted totheir training progression. This has, by and large, enabled, over the genera-tions, the successful transmission of the tenets and the skills of the clinicalpsychoanalytic corpus, and the successful careers of the collective psycho-analytic practitioner world.

There has also, of course, been a downside. Due to the separation fromthe broader intellectual academic world embedded in the university, therehas been an increasing isolation of psychoanalysis from the developments inthe many cognate disciplines of intelligence of human life, as well as fromthe research opportunities that universities are designed to make possible –indeed to deem required – which every intellectual discipline needs to growand to steadily enhance its established knowledge base. And this has inevita-bly been a major cause of the all too slow growth of research activity and aresearch tradition within psychoanalytic ranks. As early as 1968, GeorgeEngel, a well-known psychoanalyst psychosomatic researcher, and professorof psychiatry within a university, comprehensively documented his com-plaints about the psychoanalytic world’s internal and external obstacles tothe furtherance of the research by which every science necessarily grows,obstacles built into the very construction of our independent trainingprograms, with their inevitable elevation of our clinical teaching responsibili-ties, and – absent university placement – the concomitant denigration of theneed for, or the place of, the formal research that maintains scientificadvance (Engel, 1968). And this is not to speak of the fact that for theentire participating body, faculty and students alike, this entire part-time,mostly evening, training enterprise has been carried on the time and thecommitments of tired men and women.

Yet it was not until Hitler’s triumph in Germany and his subsequentmarch across Europe that the fleeing refugees transposed the bulk ofpsychoanalytic numbers from the European continent to America, and that,in this new setting, the possibility of university-linked psychoanalytictraining could arise. The American psychoanalysts, suddenly much swollenin numbers by the accession of the European Hitler refugees, with theestablished psychoanalytic prestige that they carried, were determined thatpsychoanalysis could enforce in America a path different from the proud,but at the same time lonely, isolation from the medical and academic worldsthat had marked it in Europe. It became, in effect, a major effort to captureorganized psychiatry and its formal training centers in medical schools,hospitals and clinics, and then to become its prevailing psychological theoryunder the banner of dynamic psychiatry, or psychodynamics, and thus to be



firmly planted in the midst of academic medicine, the medical school, and,via that route, in the larger university as well.

It was this effort – to transform the departments of psychiatry in the vari-ous medical schools and hospitals of our nation into bulwarks of psycho-dynamic thinking and practice – that was indeed so stunningly successfulduring the heyday of the psychoanalytic tide that swept through psychiatryin the early post-World War II years, and for a full two decades, well intothe 1960s. Then, as one after another of the Adolf Meyer-trained generationof so-called psychobiological chairs of psychiatry departments3 retired fromtheir positions of leadership, they were often replaced by psychoanalysts, orby psychoanalytically-oriented psychiatrists, determined, with the help ofpsychoanalytic clinicians, recruited to teaching and supervisory roles, tomake the teaching and learning of psychoanalytic principles, and psycho-analytic psychotherapy, the central activity of the departments of psychiatry.

And a logical extension of this campaign was the conception, alongsidethe earlier free-standing psychoanalytic institutes in the United States, inNew York, Boston, Philadelphia, Baltimore–Washington and Chicago, allcreated within the established original European model: the conception, insome receptive centers, of the university-based psychoanalytic institute as anadministrative division, quite autonomously governed, within the depart-ment of psychiatry, with at least some of its psychoanalyst teachers part ofthe full-time faculty of the medical school’s department of psychiatry –with, of course, their significant involvement in the department’s wider mis-sion and training obligations beyond the psychoanalytic institute itself. Thenew psychoanalytic institutes at Columbia, Cleveland, Pittsburgh, Down-state (now moved to New York University), and Colorado were all in thatearly wave of university-based psychoanalytic institutes established in thosefirst post-World War II decades.

The structure of these medical school department of psychiatry-basedinstitutes represented what seemed to be the most feasible compromisebetween the previously existing independent institute model, part-time, mini-mally financed, dependent largely on volunteer time and teaching commit-ments, and what, ideally, a university base could mean – a full-time studentand faculty undertaking, amply financed between student tuition and uni-versity support. The department of psychiatry placement has entailed atleast a portion of the psychoanalytic institute faculty being full-time aca-demic faculty members, but with only a portion of their time available forinstitute functioning, since they also have, properly, major commitments totheir psychoanalytically-based wider teaching and their scholarly researchactivities within the host department that underwrites their salaries.

And the institute itself would have a part-time student body, some ofthem from the psychiatry department’s faculty and students, having tosqueeze their institute training obligations out of the time needed for the

3Psychobiology at that time meant grounding in the teaching of Adolf Meyer, the study of psychiatricillness within the context of life history and life experience as it had evolved in relation to psychologicalevents and somatic ailments, but without conceptions of transference or the unconscious. It did not havethe contemporary meaning of grounding in the biological underpinning of psychiatric illness.



carrying out of their departmental academic obligations. And most of boththe institute faculty and student body would consist of private mental healthpractitioners making their part-time, independently financed commitmentsto the psychoanalytic educational process on much the same basis as theirconfr�res in the independent, non-university-based institutes.

This current arrangement for the embedding of psychoanalysis within theuniversity is, clearly in my mind, far from Freud’s, or my, ideal. At its best,it does have – at least partially – the putative advantages of a universitybase, at least some full-time faculty (but with major commitments, ofcourse, to the overall mission of the parent department of psychiatry),access to department of psychiatry resources for psychoanalytic researchsupport, and opportunities for cross-disciplinary contact and mutual enrich-ment, certainly within the medical school, and, to a variable extent, withinthe wider university community, with the social and behavioral sciences, andeven the humanities – and in the most recent years, with neuroscience. But,at its best, this overall model still leaves psychoanalysis as the only seriousdiscipline that thinks of itself as a growing science and profession, that hasan entire educational enterprise that is part-time and that rests, for the mostpart, on a volunteer, and essentially unpaid, teaching staff, with the excep-tion of only some of the faculty in medical school-based institutes who havefull-time salaried positions.

Given these current, less than ideal, circumstances, what alternative possi-bilities exist for the structure of psychoanalytic education, and for itsenhancement by psychoanalytic research? Actually, two idealistic modelshave been proposed, both extrapolations, each in a different way, of Freud’s1926 call for ‘a college of psychoanalysis’.

The first model was that of David Shakow (1962), strongly supported byDavid Rapaport, proposed particularly for the training of behavioral andsocial scientists for careers of psychoanalytic scholarship and research.Shakow’s thesis was simple and radical. He began with the statement thatour institutes, organized as part-time activities, whether independent orhoused in medical school departments of psychiatry, do not and cannottrain proper cadres of scholars and researchers in psychoanalysis. He said:

I therefore make a plea not only for the greater recognition by institutes of theimportance of research in psychoanalysis, but for emphasis on educational programsthat are oriented toward the development of persons who can contribute effectivelyto research … Suppose medical schools over the country no longer had basic sci-ence faculties, merely faculties consisting of medical practitioners who devoted apart of their time to teaching. How long could medical schools prevent themselvesfrom becoming vocational schools …. rather than professional schools, to say noth-ing of centers of research and scholarship?

(Shakow, 1962, pp. 151–2)

Shakow’s answer was to move psychoanalysis, and the education for it, inits entirety, into the university at large, as the indubitably better and morelogical home than what is currently organized within the medical schooldepartment of psychiatry, which he indeed considered an improvement overthe independent institute, but far from what can be considered optimal. His



proposal was rather that: ‘‘The psycho-analytic institute should be an inde-pendent institute in the university setting associated with both the graduateschool and the medical school’’ (p. 155), since:

the optimal arrangement would be an autonomous institute intimately related to thegraduate school and the medical school … The psychoanalytic institute could thenbe an important center of intercourse between those who are primarily clinically ori-ented and those who are primarily theoretically oriented.

(p. 156)

and he went on to adduce an array of other beneficial consequences ofthis placement as well. And it was, of course, clearly a full-time educationalmodel.

But Shakow, given his political savvy about the nature of academia, wasstrangely optimistic about the practical possibilities for some such develop-ment at that time. He said, for example:

Because of the reluctance of universities to set up independent institutes [parentheti-cally, in any realm of knowledge] on their campuses … And because the suggestionhere is that the institute have considerable autonomy and especially close relationswith the two quite separate parts of the university, it is most important that theadministration of the university as a whole, and that of the medical school and thegraduate school in particular, be strongly committed to such a program.

(p. 157)

– not to mention that such commitments would need to endure, despitethe ever shifting priorities and obligations of departmental administrationschanging over time. Nor did Shakow attempt in any way to describe howsuch an arrangement for the autonomous embedded psychoanalytic institutewould be actually constituted and operate. And nothing was said about themost salient issue of how this entire elaborate institute enterprise would befinanced.

Shakow’s whole model was clearly research-focused. The other, AnnaFreud’s (1971) prescription for what she called The ideal psychoanalytic insti-tute, and then dubbed in her subtitle, A utopia, was more centered on clini-cal training. The basic aspect of her proposal is the emphasis on the timecommitment, her call for the ideal institute as a full-time training center,albeit in her case as an independent institute on the model of her ownHampstead Child Therapy Clinic (renamed the Anna Freud Centre afterher death) which has indeed approximated her ideal in the specific realm oftraining for child analysis, but less so in the realm of the necessary concomi-tant organized research.

She contrasted the kind of training possibilities in such a setting withthat currently available in our institutes, again, whether independent oruniversity-based. Of our current training model, she said:

As it was done fifty years ago, candidates still spend their working days in non-analytic surroundings and non-analytic pursuits. They still arrive for their clinicaland theoretic seminars and lectures in the evenings or on weekends, tired out andunreceptive, at times when, by rights, they should be at leisure and pursue theirpersonal lives and interests within their families. They are still lectured to by seniormembers of the profession, who devote some off-time to teaching, often against



their real inclination, and only too often without having developed any teachingskills. Candidates still have little or no time left for reading, apart from the mosturgent course requirements, or for pursuing spontaneous theoretical interests. Tothe best of my belief, there is no other serious and ambitious discipline where part-time training schemes of this type are adopted, or where they are expected to beeffective.

(Freud A, 1971, p. 230)

Anna Freud contrasted this with the ‘‘Ideal Institute’’ with ‘‘full-time stu-dents, able to pursue their psychoanalytic studies intensively, leisurely, andwith enormously increased profit’’ (p. 230), and she ended with the acerbicstatement: ‘‘The present part-time system seems as out of date to me as ifchurch services were still conducted in catacombs since this is where theearly Christians were obliged to meet’’ (p. 230). The balance of her articlefilled out all the advantages that would accrue to our discipline in such afull-time educational institution.

Clearly, the desideratum for psychoanalytic education, as for any otherserious academic and professional enterprise is full-time immersion, full-timestudenthood. This was indeed called for implicitly by Freud, as I haveindicated, in 1926, quite late in his professional career, but quite earlywithin our psychoanalytic institutional development, and quite explicitlyby Shakow in his call a third of a century later (in 1962), when thevery significant shortcomings of our currently organized educational struc-ture were becoming evident – at least to some – and indeed has actuallybeen brought into being by Anna Freud and her colleagues, at least fortraining in child analysis, albeit under very special circumstances that AnnaFreud could quite uniquely engender.

It is within the context of this century-long developmental history,through to the accomplishments of the current medical school departmentof psychiatry-based psychoanalytic institutes, and within the siren calls ofFreud’s wishful aspirations and their fuller elaboration into full-time univer-sity models in the constructions of David Shakow and Anna Freud, thatI would like to posit, and to ponder, at this point, what I can see as an opti-mal ultimately achievable structure for full clinical and theoretical psycho-analysis within a full university home, and what would be the obstacles thatmight hinder that realization. Actually, and I trust that this is not an over-simplification, I see these obstacles in but two major domains, the one thatI will call psychological, the attitudes, predilections and prejudices on bothsides of this hoped for partnership, and the other, equally salient, the finan-cial underwriting of such a program.

I turn first to the attitudinal, the set of considerations that comprisepsychoanalytic governance, its responsibility and its authority, that mustindeed be resolved in a mutually advantageous and acceptable way. These areissues about which organized psychoanalysis has always been centrallyconcerned; its defenders would say properly, others would say defensively andobsessively. It has long been psychoanalytic dogma that to really understandand appreciate the nature of psychoanalysis one must be truly immersed in it,not only through study of its intellectual and theoretical contribution, but alsothrough experiencing it through one’s own involvement as a psychoanalytic



patient, and also then as a candidate in training and then practitioner, know-ing it thus very personally from both on the couch and behind the couch. Anda most important correlate of this conviction has been the powerful feelingthat those charged with the psychoanalytic institute task of training the succes-sor generations of psychoanalytic scholars and practitioners must themselvesof course be especially qualified psychoanalysts, selected for these tasks onlyby their own acknowledged psychoanalytic teachers and mentors. Therefore,new psychoanalytic faculty should be chosen only by existing psychoanalyticfaculty, hopefully, of course, in ways seen as respectful, impartial and fair.

This, in theory, is directly in conflict with much longer established univer-sity tenets that every hierarchic level within the university exercises responsi-bility for the academic standards operative within its purview, and nowhereis this guiding (and, if necessary, governing) process of more concern thanin the appointment of new faculty. This is exactly the issue that came intoplay in the case of the failed Cleveland Institute, one of the department ofpsychiatry-based psychoanalytic institutes from the first post-World War IIestablished cohort. There a major conflict arose between the departmentchair, actually a prominent psychoanalyst, who had originally been instru-mental in establishing the institute within the department, and the educationcommittee of the institute, of which the department chair was himself amember, but where the chair of the education committee and the majorityof its membership strongly opposed a department position, propounded bythe department chair, which involved the institute’s functioning. After a per-iod of tendentious disputation, the conflict could only come to an end withthe bulk of the institute leaving the department and reverting to the inde-pendent functioning that was, of course, the norm in most of the country.

It would clearly take a powerful commitment by the medical school as awhole and its department of psychiatry as a whole, to both the psycho-analytic idea as an intellectual undertaking, and to psychoanalytic praxis asa healing discipline, i.e. for the felt value for the department of having afully operative full-time psychoanalytic institute in its midst, its clinicaltraining as well as its scholarly activities and its empirical research allcontributing to the totality of the department of psychiatry’s mission, and,of course, to the power of the good will and the good sense of the planningmembers on both sides, for such a venture to become established – and thento enduringly prosper. And since emphases – and fashions – withinacademic psychiatry do shift, especially with changing department leader-ship, over time, the full-time psychoanalytic institute presence within thedepartment would need to be contributory enough, and valued enough, sothat it could confidently be expected to endure, almost regardless of thealtering programmatic commitments and intellectual allegiances of successordepartment leadership. (Or, alternatively, the model of a full-time autono-mous psychoanalytic institute, with essential collaborative working arrange-ments with the department of psychiatry, and equally enduring, regardlessof shifting programmatic priorities within the department.) And, of course,should such a happy set of circumstances come into being, it should bepossible for inclined psychoanalytic faculty to seek out collaborativescholarly partnerships not only across departmental lines within the medical



school, with neuroscience and with psychosomatic investigations, but also,equally, within the university at large, across the array of social andbehavioral sciences, and the humanities – philosophy and rhetoric andliterature, etc. – as well.

Whether such a development towards an established and functioninguniversity-based full-time psychoanalytic institute with a full-time faculty,and, even more, a full-time student body, can and will take place within any ofthe half-dozen presently constituted institutes within medical school depart-ments of psychiatry, or even further from present circumstance, in a fullyautonomous institute separately placed within the university at large, withlinkages both to the medical school biological sciences and the graduateschool social sciences and humanities, only time will tell – but I feel it is inkeeping with the historical developmental thrust of other intellectualdisciplines as they have, over time, gradually come into being and at somepoint been incorporated into the university academic departmental structure.Certainly the latter fully autonomous arrangement, although perhaps moredesirable in an idealized setting, seems to me of even more difficult realization.Apart from the greater material resources required to bring it into being, thereis the well-known reluctance of universities to establish such autonomousdisciplinary institutes with cross-linkages to cognate established departments,in any domain of knowledge, especially since here it would entail acknowl-edging psychoanalysis as a distinct intellectual discipline, apart from, albeitrelated to, psychology. Just as there are no distinct university departments ofMarxist studies in the university, but rather the seeing of Marxist studies as aperspective within economics, so psychoanalysis would be typically viewed asjust a perspective within the department of psychology, or within the medicalschool department of psychiatry, as a major psychology for psychiatry, for itstheory and for its therapeutic praxis.

And even with the more realizable department of psychiatry model, thereis the cautionary tale of Pittsburgh, the other of the two out of the group oforiginally post-World War II institutes established within medical schooldepartments of psychiatry that have not endured. There, an institute wasbrought into being very dramatically by an enthusiastic new psychoanalystdepartment chairman, who was able to recruit a distinguished cadre ofpsychoanalyst faculty, but it was pushed to leave the department when thesuccessor chairman, a biological psychiatrist with strong anti-psychoanalyticbiases neither valued nor wanted its presence within the department. Suchprejudices are of course intensified when the psychoanalyst faculty membershave contributed insufficiently to the academic and research goals of thedepartment.4

Yet here it is my conviction that such attitudinal issues and their embed-ding in long established institutional conventions, though seemingly so

4Perhaps in Europe and Latin America, where psychoanalysis has traditionally been less closely linked topsychiatry, the balance between the two models would be reversed, and the likelihood of thedevelopment in the direction of an autonomous independent psychoanalytic institute with linkages bothto the medical school (biomedicine and psychiatry) and to the graduate faculties (social science,especially psychology, and the humanities) might be more to the forefront than the placement within themedical school’s department of psychiatry.



entrenched in many quarters, and on both sides of this interchange, the uni-versity world and the psychoanalytic world, can indeed be brought to possi-ble successful accommodation, given the combined strong interest andgoodwill and good sense on both sides of this dialogue, working togethertowards a mutually shared, bilaterally advantageous mission. That hasindeed been the ongoing experience to date within the majority of the origi-nally established post-World War II cluster of department of psychiatry-based psychoanalytic institutes, at Columbia and New York University (for-merly Downstate) and Colorado, and at the much more recently establishedinstitute, at Emory, all operative of course within the currently existing,more limited framework than that which I am postulating.5

Of course the objection might be raised to my perspective that being atraining analyst, charged with analyzing the successor analytic practitionergenerations, requires full time-time immersion in psychoanalytic practiceand would be incompatible with the multiple other requirements of full-timeuniversity academic faculty, teaching, scholarship and research, and perhaps,for some, administrative responsibilities. But over the years our best knownand most highly regarded training analysts have in most instances also beenour most appreciated teachers in our institutes, and usually our mostesteemed contributing scholars and authors, as well as, in significantinstances, among our most productive formal researchers (in either privatepractice or in university settings). It is no longer the norm – if ever it was –that the training analysts do nothing but clinical analysis with candidateand non-candidate analysands. Nor has any fixed number of such analyzinghours ever been demonstrated to be necessary to the carrying out of thetraining analyst function. And, of course, the training analysts who are nowfull-time faculty members in those departments of psychiatry within medicalschools that currently do have psychoanalytic institutes functioning withinthe department (Columbia, Colorado, New York University, Emory) seemno less effective in their candidate training than do their non-academic con-fr�res within, or outside of, their own psychiatry department-based insti-tutes. This is despite the numerous other academic requirements thatuniversity work entails.

The more refractory problem, as I see it, is the financial burden that full-time studenthood would impose on the psychoanalytic educational process,both on the university and on the student body. Currently our candidatebody in the United States (and indeed throughout the world) consists over-whelmingly of graduated psychiatric residents, clinical psychologists, andsocial workers, with their professional degrees already achieved, engaged in

5In post-World War II Europe, psychoanalysis has also become embedded to some extent within medicalschools in various countries, first very substantially in Germany, there not in departments of psychiatrywhich tended to be the continuing bailiwick of Kraepelinian psychiatry, focused on the sicker psychoticpatients, but in newly established departments of psychotherapy and psychosomatic medicine, with theinvolvement of various medical disciplines (especially obstetrics, gynecology and pediatrics) along withpsychoanalysts, all focused on psychosomatic issues with neurotic patients, deemed amenable topsychoanalytic psychotherapy. Psychoanalysts have since also obtained professorships in many otherEuropean nations, and also in Latin America, either in departments of psychology or in medical schooldepartments of psychiatry. The issues in regard to full-time (and autonomous) psychoanalytic instituteswithin the university would therefore be quite comparable to those that would obtain in America.



full-time work, whether private practice, or partly or wholly salaried employ-ment in a mental health facility. Out of their earnings from their full-timeclinical involvement, they support their livelihoods and cover, as well, thecosts of their part-time (mostly evening and weekend) analytic training.These costs comprise in most situations their personal analyses, their super-vision hours, and their seminar fees. Within the context that I am envision-ing, the full-time psychoanalytic institute faculty would have to be verysignificantly supported by a truly substantial university commitment but, ofcourse, the psychoanalytic candidates might still be responsible for thefinancial support of their analytic hours (feeding then into the salary struc-ture of their faculty member training analysts), perhaps their supervisionhours, and, through their participation in the university tuition structure,their quota of the academic classroom costs.

What this amounts to is a total psychoanalytic training expense within thefull-time university structure that would approximate what is currently pri-vately financed out of the current earnings from full-time clinical work. Cur-rent tuition and other costs in private, i.e. not state supported, colleges andmedical schools in the United States seem to approximate $50,000 per year,and in medical schools this does not include the living expenses of studentswho are often married and raising their families. In many graduate studyrealms today – though, as far as I know, not in university professionalschools – graduate students are supported by departmental stipends, andfrom the teaching and research grants of their mentors on which they some-how manage student lives, in return for their time spent as research orteaching assistants. And in professional schools there are variable scholar-ship and loan programs, which perhaps could be extended to the psycho-analytic candidates, given sufficient available material resources, butnonetheless hardly enough at a level to make their multi-year financialobligations much different from the long-time financial burdens of themedical students. Whether such student financial sacrifice would lead to aprofessional lifetime with the income level to which physicians usuallyaspire, which is the basis of their willingness to spend so much onprofessional education, is, of course, highly problematic. It is simply thesame major financial problem – given the structure of private universityeducation in the United States – that students in other universityprofessional schools (medicine, engineering, business, law, etc.) all face.

So there is the dilemma. My own predilection is, I am sure, quite clear. Inmy mind, the long-range future of psychoanalysis as an intellectual enterprisethat can enrich the whole spectrum of human functioning in the world, andas a profession that can restore a whole range of mal-functioning individualsto securely enhanced lives, should be, and ultimately will be, as a full-timeacademic activity within a university setting. I feel reasonably optimistic thatwhat I have been calling the attitudinal obstacles on both sides, the universityestablishment and the psychoanalytic establishment, can and will be graduallyovercome, as the advantages both to society and to psychoanalysis becomeincreasingly evident.

Under what circumstances the grave financial difficulties can be overcomeis to me the central problem. To my knowledge there have been only two



settings where this has been at least in part accomplished, and in eachinstance under quite special enabling circumstances. I can end my presen-tation here by simply referring to these two instances, with both of whichI have had long personal involvement. One is The Menninger Foundationwhere I was a student and a staff member over a 17-year period during someof its heyday years, 1949 to 1966. This was indeed a full-time professionalsetting, both for its students and its faculty, both in The Menninger School ofPsychiatry and in The Topeka Institute for Psychoanalysis. Psychoanalyticfaculty and candidates carried their educational activities within the frame-work of their full-time salaried positions, and, though the candidates had topay for their analytic and supervision hours separately, the fee structure forthis was much below the comparable fees in the private sector world. Whatsustained the entire structure were the incomes generated by the inpatientsand the outpatients of The Menninger Foundation, about a quarter of thelatter in outpatient psychoanalysis, paying their fees, as all patients did, tothe Foundation, not to their therapist. Additionally, there were of coursethe impressive fund-raising abilities of Will Menninger, the nation’s foremostroving ambassador for mental health care. What was missing of course forthis acclaimed treatment center were direct university auspices with all theattendant and necessary advantages that I have indicated in this presentation.And of course, the psychoanalytic institute and its training structure were stillonly part-time activities within the overall Foundation functioning. And inthe end, faced with skyrocketing costs, plummeting insurance reimbursements,sharply shrinking hospital stays, and Will Mennninger’s death, the entireedifice became unsustainable, and the Foundation saved itself by findinga university home as the Department of Psychiatry at Baylor College ofMedicine in Houston, Texas, but stripped of its psychoanalytic institute.

My other example is the Anna Freud Centre in London – before herdeath it was called the Hampstead Child Therapy Clinic – created originallyby Anna Freud as a full-time children’s outpatient treatment center as wellas a site for full-time clinical training, just in child analysis, with studentsfrom around the world, many from America. It operated under very specialcircumstances, the rallying of major resources in the psychoanalytic world,as well as in the private foundation and National Institute of Mental Healthgrant-giving world, around the persona of Anna Freud, lasting throughouther lifetime, combined during that period with the far lower budget andoperating costs than a comparable institution in the United States wouldhave entailed. And there too, financial, as well as programmatic, pressureshave pushed the Anna Freud Centre, in its educational activities leading toa master’s level degree, into a now achieved ongoing program link with thePsychoanalysis Unit in Health Psychology at University College London –reflected incidentally in major program enhancement. However, it is stillindeed a full-time educational enterprise.

In addition, there is actually a third example, this of a program to create,not a clinical psychoanalyst, but a doctoral level mental health professional,called a Doctorate of Mental Health (DMH). This was a five year, full-time, post-college program created by me and my group in 1973 in the SanFrancisco Bay Area as a consortium of UC Berkeley, UC San Francisco



with its medical school’s Department of Psychiatry’s Langley-Porter Insti-tute, and the Mt. Zion Hospital Department of Psychiatry. It was an effortto combine the most relevant teaching from offerings of medical school,doctoral clinical psychology and school of social work programs, into a cur-riculum designed to fashion a mental health professional fully competent inthe three central domains of mental health practice, (psychoanalytic)psycho-therapy, psychoactive medication management, and, for the severestcases, hospital care.

The DMH program consisted of two pre-clinical academic years at UCBerkeley, and then three clinical years alongside the psychiatric residents,both at the Langley-Porter Institute and the Mt. Zion Hospital. The stu-dents – all full-time – were afforded modest stipends from foundation grantsupport that we were able to obtain in order to launch the program, withadditional support secured for an intense evaluation component to assessstudent progress and performance in comparison with the psychiatric resi-dents. We had nine classes, ranging in size from six to twelve each, andgraduated about 75, before the program was closed by the university in1986, after 13 years, out of a combination of budgetary pressures within theuniversity during those years, and the staunch opposition of the state medi-cal and psychiatric associations to the effort in the state legislature to estab-lish a licensure examination for our graduates. Actually, most of thegraduates have secured clinical psychology licenses in the various stateswhere they are now practicing.

And, of course, the DMH program was designed to create a mentalhealth professional, practicing psychoanalytic psychotherapy, not a fullclinical psychoanalyst, though a significant number have gone on – verysatisfactorily – through subsequent psychoanalytic institute training. Butagain, this was indeed an example of full-time, psychoanalytically-basedclinical training within a university context, leading to a university doctoraldegree. A book was published, with chapters by faculty and graduatedstudents, recounting the entire program history, from conception andrationale, through to termination, and including the program evaluationfindings (Wallerstein, 1991).

It’s not clear to me that any of these models can be duplicated, or offerclear guides to the fashioning of full-time education in the theory and praxisof psychoanalysis within the current American (or any) university structure.But they do point to the possibility that, properly engineered and properlysupported, both from within the university world and the psychoanalyticworld, something of what I have been proposing in this presentation, canindeed, maybe only incrementally, and maybe to begin with only in particu-lar favorable settings, come into being. But unless some significant segmentof our educational and training structure does achieve emplacement withinthe university academic world in something like what I propose here, I feelthat our psychoanalytic future, both as a theory of mental functioning andas a major remedial approach to disturbed mental functioning, will gradu-ally become increasingly marginalized and diminished. What I propose hereis a vision that I feel necessary for the long-term future well-being of ourdiscipline.



Translations of summary

Psychoanalyse an der Universitat – eine Vollzeitvision. Die Psychoanalyse nimmt als Disziplin,die sich als Ausbildungsprojekt in einem privaten Teilzeitsetting außerhalb der Universit�t entwickelt hat,unter den wissenschaftlichen Disziplinen und akademischen Professionen eine Sonderstellung ein. Freudh�tte es gern anders gesehen, doch in Mitteleuropa war eine universit�re Anbindung der Psychoanalysezur Zeit ihrer Entstehung nicht mçglich. Nach dem Zweiten Weltkrieg wurden in Amerika in manchenpsychoanalytischen Ausbildungszentren die psychiatrischen-psychoanalytischen Institute als Fachbereicheder Medical Schools gegr�ndet, die die Unzul�nglichkeiten der traditionellen psychoanalytischen Ausbil-dung aber nur teilweise korrigieren konnten. Der Beitrag untersucht die Mçglichkeiten einer vollst�ndiguniversit�tsgest�tzten, ganzt�gigen Ausbildung.

Psicoanalisis en la universidad: Una vision de tiempo completo. El psicoan�lisis puede con-siderarse fflnico entre las disciplinas y profesiones acad�micas, ya que se desarroll� como proyecto educa-tivo en un contexto privado y de medio tiempo, fuera del sistema universitario. Freud habra querido quelas cosas fueran diferentes, pero en Europa Central, donde se cre� el psicoan�lisis, la inserci�n de �ste enel sistema universitario no fue posible. En los Estados Unidos, luego de la Segunda Guerra, surgi� enalgunos centros de formaci�n psicoanaltica el concepto de un departamento de psiquiatra, dentro de lafacultad de medicina, que poda constituirse como instituto psicoanaltico. Sin embargo, este proyectosolo pudo superar parcialmente las deficiencias educativas y de investigaci�n de la formaci�n psicoanal-tica tradicional. Se explora aqu la posibilidad de crear una estructura de formaci�n psicoanaltica de ti-empo completo asentada en la universidad.

Psychanalyse a l’universite: une vision a plein temps. La psychanalyse pourrait Þtre la seule par-mi les disciplines et professions savantes s’Þtre d�velopp�e en tant qu’entreprise �ducative dans un cadre temps partiel et priv� en dehors de l’universit�. Freud aurait aim� qu’il en soit autrement mais en Eur-ope centrale, lorsqu’elle fut cr�e, qu’elle trouv�t sa place l’universit� n’�tait pas possible. En Am�rique,apr�s la deuxi�me guerre mondiale, le concept d’institut psychanalytique des services de psychiatrie des�coles de m�decine fut �tabli au sein de quelques centres de formation psychanalytiques mais il ne putque partiellement surmonter les insuffisances, en termes de formation et de recherche, de la formationtraditionnelle la psychanalyse. Les possibilit�s de d�velopper une v�ritable structure de formation plein temps bas�e l’universit� sont explor�es.

Psicoanalisi nelle Universita: prospettiva del tempo pieno. La psicoanalisi � probabilmente unicafra le discipline accademiche ad essersi sviluppata come attivit educativa in un ambito part-time, al difuori delle universit. Freud avrebbe sicuramente preferito altrimenti, ma a quell’epoca, in cui la psico-analisi stava nascendo, l’universit del centro Europa non poteva accogliere questa disciplina. In Amer-ica, dopo la seconda guerra mondiale, si fece strada il concetto di dipartimento di scuola medicaall’interno di istituti psichiatrici e psicoanalitici ma questo fatto riusc� solo in parte a ovviare alle carenzedidattiche e all’inadequatezza della ricerca accademica che presentava la tradizionale formazione psico-analitica. In questo lavoro si indaga sulla possibilit di creare una struttura universitaria che promuovala formazione psicoanalitica a tempo pieno.

References

Engel GL (1968). Some obstacles to the development of research in psychoanalysis. J Am Psy-choanal Assoc 16:195–204.

Freud A (1971). The ideal psychoanalytic institute: A utopia. Bull Menninger Clin 35:225–39.Freud S (1926). The question of lay analysis. SE 20, 177–258.Lippmann W (1966). The university. New Republic, May 28.Shakow D (1962). Psychoanalytic education of behavioral and social scientists for research. In:Masserman JH, editor. Science and psychoanalysis, vol. 5, 146–61. New York, NY: Basic Books.

Wallerstein RS, editor (1991). The doctorate in mental health: An experiment in mental health profes-sional education. Lanham, MD: UP of America.

Wallerstein RS (2007). The optimal structure for psychoanalytic education today. A feasible proposal?J Am Psychoanal Assoc 55:953–84.



psychoanalysis in the university: a full-time vision

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