AMERICAN PSYCHOANALYTIC ASSOCIATION

Despite Sigmund Freud's concern about the fate of psychoanalysis in the United States, it has been the country where psychoanalysis, as theory and as therapeutic enterprise, has been most successful during its first century.

Accompanied by Carl Gustav Jung and Sándor Ferenczi, Freud made his first and only trip to the United States in 1909, visiting Clark University at the invitation of G. Stanley Hall. At that time he received an honorary doctorate in law for his contributions to psychology. This visit came at a time of crisis in sexual morality following the oppression of Victorian sexuality, a time of change in the structure of American family life with a move towards smaller families, and also at a time of crisis in the treatment of nervous and mental disorders. Facing such pressures, American psychiatrists found the psychoanalytic focus on the emotional relations of love and hate among family members to be revealing and important.

Within ten years of Freud's visit, psychoanalysis was broadly accepted in the United States. At first it was seen as another form of the then-current psychotherapies of suggestion. Its increasing popularity, displacing other therapies, was a result in part of the public's welcome of its optimistic view of mental illness, emphasizing environmental causes and its accessibility to "cure," in contrast to European theories of hereditary degeneration.

The year 1910 was of great importance to the history of psychoanalysis. In his paper "Wild Psycho-Analysis," Freud voiced concern that the use of psychoanalytic notions by those psychoanalytically untrained could be harmful to patients. To protect the public, and the scientific integrity of psychoanalysis, he and his followers founded the International Psychoanalytical Association (IPA), in which membership would be available only to those trained in the psychoanalytic method. Those few Americans who were trained psychoanalysts formed the American Psychoanalytic Association (the American) in 1911. The purpose of the American association, like that of the IPA, was to promote communication and to define what constituted a psychoanalyst in order to protect the public from "wild analysis." Ernest Jones (who would become Freud's first official biographer in the 1950s) had written to Freud that "already in America there are many men exploiting it for financial and other reasons, whose knowledge of the subject is minimal, and who only bring discredit on the work. . . . no one will be elected member of the association unless he has shown some competence in the work."

Freud's continuing concern led, in 1918, to the establishment of an Institute for psychoanalytic education and training in Berlin, with Vienna and London following soon thereafter. These institutes offered a well thought out curriculum that consisted of instruction in the scientific theory of psychoanalysis, supervision in the treatment of patients using psychoanalytic methods, and a personal experience of psychoanalysis. This "tripartite" form of training came to be the model throughout the psychoanalytic world: personal analysis, psychoanalysis of patients under supervision, and didactic course work.

That same year also witnessed the publication in the United States of the Flexner report, a startling exposé on the absence of standards in medical education. About half of the existing medical schools were forced to close, and in those remaining, great efforts were made to exorcise charlatans from therapeutic activity and guarantee that a medical degree was the hallmark of proper training and competence. German and Viennese medicine was prestigious at the time, and in attempts to upgrade their standards, Americans looked to them to provide models.

The fields of psychiatry and neurology were also in their formative stages, and since the American conception of medical science was then similar to that of Freud's, that is, a reliance on clinical judgment based on observations made in the individual case, psychoanalysis brought a degree of respectability to psychiatry. On the other hand, the leaders of analysis in New York believed that psychoanalysis gained respectability and prestige from an alliance with medicine and assured it a serious hearing. The American Psychoanalytic Association was eager to retain this respectability, and by 1924, under the influence of the New York Psychoanalytic Society and the concerns secondary to avoiding accusations of quackery, the American had adopted the requirement that members be physicians. Freud and most of the European psychoanalysts protested this change. They believed strongly that psychoanalysis did not belong to medicine. Rather they believed that psychoanalysis was part of a general psychology. The issue of the training of lay analysts was an issue that would persist.

World War I brought prominence to Freud's theories of the irrational and the brutal in human nature. His methods and their derivatives also proved to be the most effective then available for the treatment of "shell shock." Many psychiatrists subsequently became interested in psychoanalysis as a treatment method, and travel to Europe for psychoanalytic education at one of the newly established institutes became popular. On their return, those so trained contributed to the establishment of psychoanalytic societies in several American cities. This began another chapter in American psychoanalysis. Freud maintained that although rigorous training was necessary to become a psychoanalyst, psychoanalytic education and training should be available to a wider group, not simply to psychiatrists. But the Americans held firm, and among those who had traveled to Europe to train at European institutes, only the psychiatrists were eligible for membership in the American Psychoanalytic Association upon their return. Heated international debate about this policy followed and continued for decades.

By the 1930s, psychoanalytic societies had been established in several cities in the United States. However, it was not until 1931 that the first Institute for Psychoanalytic Education was established. New York's was the first, but Chicago, Boston, and Baltimore-Washington followed shortly thereafter. Once established, these institutes were committed to maintaining the highest possible standards of psychoanalytic education. Thus in 1932, with the reorganization of the American Psychoanalytic Association as a federation of constituent societies, a Council on Professional Training was formed to establish and maintain policies and standards of teaching, so that psychoanalytic education would maintain some consistency as the various institutes were established. In 1938, this council published the "Standards and Principles of Psychoanalytic Education." Although many revisions have taken place, this document remains the definitive statement that guides psychoanalytic education at all constituent Institutes of the American Psychoanalytic Association. The model of education continues to be predominant as the model first established in the first Institute in Berlin. It is a tripartite model, which includes a personal analysis, psychoanalysis under supervision, and class-work. This has been the core training of all subsequent psychoanalytic Institutes (with a total of twenty-nine by the end of the twentieth century). In 1946 the American Psychoanalytic Association again reorganized. This time two governing bodies were established; a Board on Professional Standards became responsible for all matters of psychoanalytic education, and an Executive Council was established to deal with membership and practice issues.

The years following the World War II again saw increased professional status for psychoanalysts, particularly as derivatives of its methods proved to have the greatest success in treating psychological disturbances brought on by war combat. Furthermore, at a time before psychotropic medications became available, psychoanalysis and its derivative therapies proved among the most successful methods of treating many varieties of mental disturbances. As a result, psychoanalysis became highly influential in psychiatric education and a large number of university psychiatric residency programs had a psychoanalyst as chairman.

Many have described the years between 1945 and 1965 as the golden years for psychoanalysis in the United States. Psychoanalysis in Europe had barely survived outside of London, and many European analysts had found their way to the United States. This brought a wealth of intellectual energy to American psychoanalysis and interest in the theoretical basis of psychoanalysis enjoyed great popularity. In addition, the patient pool was large, not only because of the dearth of alternative methods, but also because artists and intellectuals felt that engaging in psychoanalytic treatment freed their creative minds. The wealth of clinical experiences led to ever-expanding theories to explain the clinical observations. Nathan Hale points out that during this period the "Popular images of Freud revealed him as a painstaking observer, a tenacious worker, a great healer, a truly original explorer, a paragon of domestic virtue, the discoverer of a source of personal energy and a genius" (1995, p. 289). All of these attributes reflected idealized American cultural values. With such an idealized image of Freud and of psychoanalysis, disillusionment was inevitable. However, one must balance the valid criticisms of the pretensions of psychoanalysis to be a globally explanatory treatment with the attendant and inevitable failure of psychoanalysis to deliver the kinds of idealized expectations that had been established during this "golden age."

An account of psychoanalysis in the United States would not be complete without taking into account the issue that would not go away, that of "lay analysis." Psychoanalytic education in the United States was limited to psychiatrists from the beginning. In 1957 a provision was made whereby psychologists of exceptional research talent could gain access to psychoanalytic education under the proviso that they simply use their psychoanalytic skills to further their research and not attempt to treat patients. However, it was not until 1986 that provisions were made to allow certain non-medical clinicians to gain access to psychoanalytic training. The American Psychoanalytic Association has now reached a point where it is striving to define eligibility for psychoanalytic education on more than the basis of an academic degree.

There were major ramifications to the exclusionary policies of the American Psychoanalytic Association. These policies guaranteed that advancements in the field of academic psychology would exclude a consideration of psychoanalytic theory because psychologists who might have been interested in the integration of psychology and psychoanalysis were not given access to psychoanalytic education. This meant that psychoanalysis could not benefit from the research methodology available to psychology, and as very little emphasis was given to research in medical education until recent years, psychoanalysis has suffered from the paucity of research which might have offered some validity or reliability to its theoretical positions.

A central event for psychoanalysis in the United States was a class-action anti-trust lawsuit filed in 1985 by four psychologists. This group alleged that the American Psychoanalytic Association, the New York Psychoanalytic Institute, the Columbia University Center for Psychoanalytic Training and Research, and the International Psychoanalytical Association had "restrained and monopolized interstate and international trade and commerce in the training of psychoanalysis and in the delivery of psychoanalytic services to the public" (Schneider and Desmond, p. 322). By 1989, a settlement agreement was approved. The terms of the agreement changed the face of psychoanalysis in the United States: (1) Psychologists and other qualified non-medical clinicians were eligible to train in the institutes of the American. (2) Members of the American were permitted to teach in non-American affiliated institutes. (3) Membership in the IPA was now open to all qualified psychologists and non-medical psychoanalysts. As a result of these changes the American Psychoanalytic Association has become a more inclusive organization. In addition, the American has joined a psychoanalytic consortium with psychoanalytic colleagues in other organizations: Division 39 (Division of psychoanalysis) of the American Psychological Association, the Academy of Psychoanalysis, and the National Membership Committee on Psychoanalysis in Clinical Social Work. This Psychoanalytic Consortium has worked jointly on a variety of social and political issues important to all psychoanalysts, including maintaining the privacy of the psychotherapist-patient relationship, and is working towards the development of a board to accredit institutes from the entire spectrum of psychoanalysis, in order to protect the high quality of psychoanalytic education and psychoanalytic treatment.

One hundred years after the publication of the Interpretation of Dreams, and over ninety years since Freud's memorable visit to the United States, the American Psychoanalytic Association, in the best Freudian tradition, is once again actively reaching out to psychologists, psychiatrists, mental health professionals, academics, and the lay public. These new endeavors have infused the organization with vitality. With an appreciation of its past, the American Psychoanalytic Association has risen to the challenges of the new century.

Leon Hoffman and Sharon Zalusky

See also: American Academy of Psychoanalysis; Journal of the American Psychoanalytic Association; Law and psychoanalysis, Lay analysis.

Bibliography

Desmond, Helen, and Schneider, Arnold Z. (1994). The psychoanalytic lawsuit: expanding opportunities for psychoanalytic training and practice. In Robert C. Lane and Murray Meisels (Eds.), A history of the division of psychoanalysis of the American Psychological Association (pp. 313-335). Hillsdale, NJ: Lawrence Erlbaum Assoicates Publishers.

Hale, Nathan G. (1971). Freud and the Americans. New York: Oxford University Press.

——. (1995). The rise and crisis of psychoanalysis in the United States. New York: Oxford University Press.