With the passage of a law in NY State that establishes the licensing of psychoanalysts, and with movement toward similar laws taking place in various other states, questions about the formal status of the profession: how credentials are established, what the standards of training should be, who should decide such matters, etc., are once again in the air. Now that there is a new political and social meaning to be given to the term "psychoanalyst" as an independent licensed profession, it would seem that even those who practice psychoanalysis under the rubric of their own licensed profession, such as the majority of the members of Division 39, must take account of the changing status that their profession will have in the public sphere.
Indeed, the efforts to establish psychoanalysis as a licensed independent profession under state laws governing professional practice have created a perplexing philosophical or, in the fullest sense, ethical problem for psychologists who practice psychoanalysis. While many agree with the proposition that psychoanalysis can and should be viewed as a distinct and independent clinical discipline, that in both its theory and its practice, it stands on its own, related to but independent of the three disciplines of clinical mental health (Psychiatry, Clinical Psychology, and Clinical Social Work), invoking the regulatory powers of the State seems like a poor way to recognize this independence. The philosophical principle itself--that psychoanalysis is an independent discipline with its own history and identity--seems valid, the political action, that it be licensed as an independent profession seems ill advised. Nevertheless, this change in the law is exactly what is happening (and has happened) in a number of states.
One of the immediate consequences of bringing psychoanalysis under the law of professional licensure is that the training of psychoanalysts becomes a legally governed action. It is no longer a question as to whether a given training program will be affiliated or not with the American or the International Psychoanalytic Association. It becomes a question as to whether that training program can, under the law, claim to be training psychoanalysts at all. This first consequence quickly leads to another: those who decide which training programs are acceptable and which are not, and those who define the principles by which that inclusions/exclusion shall occur have the real political power to define psychoanalysis de jure in their particular state. These facts clearly have the potential to profoundly affect the de facto character of psychoanalysis in the coming years.
Between five and ten years ago, becoming aware that these changes were being considered by various state legislatures, Members of the Division of Psychoanalysis (Division 39) of the American Psychological Association were understandably concerned about this new certification power. As a response, Division 39 was instrumental in forming, together with representatives from Psychiatry and Social Work, a group that has come to be known as the Consortium on Psychoanalytic Training. The Consortium produced a report on its recommendations for training standards that was released in 2004. However, the standards that were used in the development of the NY State Law that passed at about the same time were not those of the Consortium but rather those developed by The National Association for the Advancement of Psychoanalysis, a group that takes a stand independent of the "tri-disciplines."
In political terms, those groups (including Division 39) who took the position that psychoanalysis should be governed under the (combined) authority of the mental health professions lost in NY State to a group that was arguing for the position that psychoanalysis can stand on its own as an independent profession. It is of more than passing interest that this political debate echos the debate about "lay analysis" that has been a part of the history of psychoanalysis from nearly its inception. Initially, the debate was about medical vs. non-medical practitioners, but the arguments are very nearly the same when the question is between mental health vs. non-mental health trained practitioners.
One thing is certain: this whole matter has become such a tangle of ethical, philosophical, and political concerns, that it is extremely difficult for many of us to find a clear and coherent point of view. In response, many established psychoanalysts who are licensed within their respective mental health professions have essentially thrown up their hands, safe in the knowledge that they will not be directly affected. However, can anyone who is dedicated to the field of psychoanalysis not be concerned with its social and political fate?
Section V was established within Division 39 to represent and foster diversity and pluralism in psychoanalysis. While this is a point of view sanctioned by the Division as a whole, it is the specific mission of Section V to be especially attentive to the interplay between orthodoxy and innovation in our field. The debate about standards of training, governance of the boundaries of our field, and the political power to define the legal status of psychoanalysis touches upon the central concerns of this section.
It is our view that we can no longer afford to simply oppose the efforts to license psychoanalysis as an independent profession but instead should work to influence the way that licensure is governed. We should no longer simply assert that psychoanalysis is a specialty within the mental health field, but work to influence how it will be conceived as an independent discipline. We have an ethical responsibility to enter the debate regarding the conception of this independent profession, not retreat into the illusory safety of our professional status as psychologists.
How can psychoanalysis survive as simulatenously rigorous and innovative? How can it continue to be open to the contributions that come from outside the mental health disciplines without being diluted in its clinical intent and efficacy? Can we turn the decisions made by State legislatures into an opportunity to strengthen the field rather than viewing it as a defeat?
The Section V Invited panel at the Spring 06 meeting of Division 39 featured a discussion of the questions raised here by editor David Lichtenstein
"The Licensing of Psychoanalysts: Re-considering the Question of Lay Analysis" a round table discussion with Nancy McWilliams as moderator, and with Lewis Aron, Virginia Goldner, David Lichtenstein and Laurel Wagner participating.
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