Posted by Dr. Vollmer on March 2, 2015
How do you become a psychotherapist? How do you become a teacher for psychotherapists? Who should be the students? Is it necessary to have a science background? How many years should it take? How many internship hours should one put in? Who should license psychotherapists? Should this be a State license or a federal license? What about lawsuits? What can people sue for? What is evidence that things went wrong in psychotherapy? These are the endless questions in which my field is dazed and confused. Psychoanalytic institutes have a model for training; a model hotly contested, since there are no empirical studies. Traditional institutes have a tripartite model which includes a personal psychoanalysis, four years of classes, and three cases under weekly supervision, where the student goes for one hour a week to report on a patient who is seen four times a week. The lines between supervision and psychoanalysis blur, because since the student goes to his/her own psychoanalyst four to five times a week, then maybe the student should bring his/her questions to his/her therapist and not a separate supervisor. And who becomes a supervisor is yet another question?
Currently, I am working towards passing an examination which will, in one boutique of psychoanalytic training, consider me both a training and a supervising analyst. The training analyst part means that I will see therapists who want to become psychoanalysts, in psychoanalysis. The supervising part has those “fifty shades of grey” which can, as the movie suggests, contain an erotic component. The boundaries in psychoanalysis are clear. The patient comes at a particular time, they pay a fee, and the subject of discussion is the inner workings of the patient’s mind. The boundaries in supervision are subject to interpretation, and hence not clear. The student is supposed to talk about his patient and the supervisor is supposed to give thoughtful feedback, but as with all dyads, unique dynamics develop and the utility of the process is open for question.
In my new study group, we are reading articles about the controversies around supervision, and once again, I am struck at the arbitrariness of the process. Howard Bacal MD writes “a pedagogic ‘big bang’ occurred within the psychoanalytic universe. The ‘tripartite’ system of analytic training officially came into being with the strict separation of its three modalities.” In other words, a model appeared, and it has stuck, and so I am stuck in it. I do not mean that I do not have options, but I do mean that understanding the history enlightens me in that I can work within the model, or I can try to change it. For now, I am working within the model, while generating fantasies about how to change it. The jury is not out whether group supervision is superior or inferior to private supervision. The jury is also not out whether a supervisor should “graduate” to this status by passing an examination, or whether a supervisor should be defined by years of practice. For now, I am growing by learning, even if I am learning just how random professional development can be.