To kick off the 2018-2019 academic year, Chaim E. Bromberg, Ph.D., co-director of Manhattan Institute’s Licensure Qualifying Program in Psychoanalysis, discusses the legacy of lay analysis and the changing landscape of the field over the past 100-plus years. Who, he wonders, is listening to psychoanalysis today? Who now is speaking?

 

Anybody following discussions in contemporary psychoanalytic circles, listserv posts, and in the media is familiar with the call to arms: Psychoanalysis is under siege! Our treatment model is devalued, dismissed, harshly (mis)characterized, or simply ignored. Policy makers, insurers, universities, and training hospitals turn away from what we have to offer, sometimes with hostility and sometimes with indifference, and as a result not only patients but entire generations of new psychotherapists overlook our methods for understanding human experience and healing the lives of people in distress.

It would be an understandable mistake to believe that this state of affairs exists the world over, but a mistake nonetheless. In parts of Latin America, for example, psychoanalysis is thriving, celebrated, and respected. In Europe, psychoanalytic institutes may be struggling to recruit candidates, but psychoanalytic perspectives are not denigrated in the same way they are here. Why, then, does psychoanalysis face such an unwelcoming public response in the States?

This is a question with many answers, but I would like to focus on one in particular: The legacy of lay analysis and the United States’ history of uniquely hierarchical and rigid boundaries erected to preserve a medical monopoly on psychoanalysis. Sigmund Freud was a staunch supporter of lay analysis and rejected the argument throughout his life that physicians alone should be authorized to practice as analysts, most notably in his 1926 book, The Question of Lay Analysis. Despite Freud’s interventions, beginning in 1938, the American Psychoanalytic Association required that applicants be physicians trained as psychoanalysts. It was not until four psychologists brought a lawsuit against the APA almost half a century later, in 1985 (subsequently settled in 1988), that nonmedical candidates began to receive free and unfettered access to psychoanalytic training. Our own institute was founded with the goal of making training in interpersonal psychoanalysis available to nonmedical candidates, including social workers and psychologists.

In 2010, New York State implemented Article 163, creating four new categories for licensure: Creative Arts Therapy, Marriage and Family Therapy, Mental Health Counseling, and Psychoanalysis. For the first time, a student of psychoanalysis could receive a license to practice without becoming licensed as a psychiatrist, psychologist, or social worker. This legislation allowed for the creation of the Manhattan Institute’s Licensure Qualifying Program (LQP) in 2012.

I want to make the case that this development not only more closely aligns American psychoanalysis with Freud’s original vision and with the practice of psychoanalysis worldwide, but also creates enormous opportunity for addressing the isolation and marginalization of psychoanalysis within American culture. When the medical establishment consolidated its grip on American psychoanalysis in 1938, psychiatrists were in a position of great cultural power and influence, regarded as high priests and revered as interpreters of the human condition. The world was listening, and psychoanalysis was in no danger of being marginalized. But as cultural values shifted, for better, for worse, and otherwise, this very same consolidation of power left us with fewer avenues for sharing our models of mind and our methods of treatment with researchers, clinicians, and theorists and scholars outside of our gated communities, not to mention with the broader culture. In fact, as developments in other scholarly disciplines and in American culture challenged both core psychoanalytic concepts and the authority of psychoanalytic knowledge, this isolation served only to delay the intellectual work of deeply and nondefensively examining these challenges to psychoanalytic theory and practice. In the meantime, the world moved on, biochemical and behavioral models of mental illness and treatment became dominant, and economic and cultural forces further eroded the value of psychoanalysis in America.

Delayed or not, the changes in psychoanalysis over the second half of the 20^th century and into the present have been profound and consequential. Today, contemporary psychoanalysis is home to rigorous scholarship exploring issues of power, gender, sexuality, identity, epistemology, development, and more. These studies remain rooted in the examination of the clinical encounter, and therefore also teach us how differences are negotiated between real people in today’s world. These insights are as important today as they have ever been.

Now we return to the problems of influence, stature, and dialogue: Psychoanalysis has grown as it has listened to its detractors and engaged with their criticisms. But is anyone listening to psychoanalysis? If it is truly our goal to dialogue with the rest of the world, then I believe we could not be better served than by embracing the contemporary leading edge of lay analysis, our LQP candidates. They come to our institute from within and outside of the world of mental health treatment, from business, from academia, and from the arts, in order to devote themselves to the study of psychoanalysis. They have a passion for psychoanalysis, they pursue a long and intensive training in psychoanalysis, and they very often maintain their professional and personal connections to disciplines psychoanalysis has long since ceased to dialogue with. Who better to serve as emissaries? Who better to further our communication with the world at large, to open conversations far beyond the doors of our institutes, to show others that talking with – and listening to – one another can help to build community, strengthen connections, and ultimately knock down walls?

 

Chaim E. Bromberg, Ph.D., is a psychologist and psychoanalyst in private practice in Harrison, New York. He is co-director of the Licensure Qualifying Program in Psychoanalysis at Manhattan Institute for Psychoanalysis, where he is also on the teaching faculty. He is on the voluntary faculty of Weill Cornell Medical College; teaches and supervises at the Westchester Division campus of New York-Presbyterian Hospital in White Plains; is on the visiting faculty of the Westchester Center for the Study of Psychoanalysis and Psychotherapy; and is a visiting instructor in the Psychiatry Residency and Psychology Internship Programs at The Albert Einstein College of Medicine at Montefiore Hospital in the Bronx.