Crucial Choices, Crucial Changes

The Critical Need for Improved Methods for Selecting Future Psychotherapists

Can an unpleasant truth defeat a pleasing lie? —Ibsen

Unsuitable candidates are accepted as psychotherapy trainees, and we have no procedures for determining who is qualified. It is like freely admitting the tone-deaf and the ungifted as musicians so long as they have book knowledge about music. Incompetent musicians would become the majority and would rule the world of music. They would also publish papers in which they abundantly quote other incompetents to reinforce their positions. As in politics, the belief of the many is strengthened by the reassurance that multitudes follow in the same track. Fortunately, there are too many knowledgeable musicians around to allow the unencumbered admission of incompetents. That is not the case in psychotherapy. To paraphrase the words of the philosopher, rare indeed is the professional who has enough expertise and sincerity to say what he means and mean what he says.

The present system of selecting trainees for careers in psychotherapy is comfortable and advantageous for the academic institutions and the training institutes, as well as for the educators and professionals involved. It is disastrous, however, for the gifted student and for the quality of patient care. We need to consider the selection practices of the training institutes from the viewpoint of the training institute, the applicant, and the public interest.

The literature about admission to training is not abundant, and what there is ranges from the shallow to the mediocre. Even though the issue is of primary importance, the pervasive attitude is that the present system, comprising a series of interviews by institute members, is acceptable. A few of the papers suggest procedures that could be followed in addition to the interviews. Among those suggestions are psychological tests, trial analyses, and looking at the applicant’s work with patients. The latter is the most interesting, but of course it could not be done until the candidate had already engaged in enough preliminary studies to allow him or her to start supervised work. As far as one can determine, the only one of those suggestions that has ever been followed is the use of psychological tests, which a few training centers use as a minor adjunct to the basic interviews.

The various papers present a shopping list of the noble qualities the candidate should possess plus another list of the shortcomings that would exclude him or her. Among the latter we find a number of neurotic traits. Now, one would expect that those traits would eventually be worked through in the candidate’s personal analysis. It is bizarre to expect the candidate to be free of the neurotic traits that are the very material of his or her analysis.

The institutes claim that both the positive and the negative factors can be satisfactorily established through interviews and the study of the candidate’s life history, as related by him or her.

Can the institutes actually accomplish this feat, or do they advance those naive claims for their own self-interest? Let us consider a simple example. Honesty and a sterling character appear frequently on the list of desirable traits. Their presence in the candidate is established by the candidate’s answers to questions intended to discover the candidate’s true motivation.

Does this person want to explore the truth about the human psyche, or does he or she want to have a comfortable income and livelihood? Unless the interviewing faculty members are clairvoyants with unheard-of capacities—in fact, omniscient—they must take the candidate’s answers at face value. Most applicants are clever, though not necessarily in the aspects that would qualify them to the profession of psychotherapist. They have a fair understanding of the orientation and policies of the institute in question and what the interviewers are looking for and will phrase their answers accordingly. If they have sociopathic tendencies, they will even do better.

Robert Wallerstein (1991), The Doctorate in Mental Health, Lanham, MD, University Press of America, speaking from his own experience, states, “The psychiatric residents devoted considerable time and energy to learning from, and also to impressing, their psychoanalyst teachers, hoping that all this would eventually facilitate their acceptance by the [Psychoanalytic] Institute.”

Phyllis Greenacre (1961), “A Critical Digest of the Literature on the Selection of Candidates for Psychoanalytic Training,” Psychoanal. Quart. 30, in one of the better papers dealing with the selection of psychotherapists, pointedly states: “We frequently hear expressed as a positive recommendation of an applicant that he has a “psychological gift’ or ‘access to the unconscious’ or ‘a high degree of intuitive understanding.’ Is it feasible to determine in preliminary admissions interviews how this psychological gift has been used and has seemed to influence the applicant’s life.” In short, Greenacre doubts that such a gift can be detected in the interviews.

That position is held by many sincere analysts. For example, Grete Bibring (1954), “Training Analysis and Its Place in Psychoanalytic Training,” International J. Psycho-anal, 35, as mentioned by Greenacre, decries the preponderance of career seekers in applicants as well as the preponderance of character problems, rather than neuroses. We need only look at some of the professionals populating the field of psychotherapy to know that this is true. Are they really the people we want to see in this profession?

Thus, as we can readily note, nothing has substantially changed in all these years, except the admissions criteria, which have become even more relaxed. The institutes continue to employ interviews to the exclusion of better procedures. The faculty members consistently claim that this method of selection is not merely adequate but erudite and sophisticated. Their descriptions of the interview procedures are masterpieces of scholarly language and thought. The reader will have to decide how much rationalization is involved here, but this we know is true: interviews are the easiest procedure for the faculty members to use. They are also the worst.

It is not easy to establish which applicants possess the necessary sensitivity and talent eventually to become qualified psychotherapists. There are three methods, and I shall discuss them in order of their efficacy.

The best procedure is to place the candidate for training into an intensive psychotherapy group. He or she should be the only psychotherapy trainee in the group; otherwise, undesirable disturbing elements will make their appearance. Although the method would be cumbersome, it is feasible nevertheless. Here is one of the many examples of how talent can become evident. One of the most gifted people I ever encountered for the profession of psychotherapy was a young commercial artist who attended one of my groups. He was unassuming and reserved.

He had no psychological education or prior psychotherapeutic experience. He did not speak up frequently, but when he did, his comments showed unusual understanding of other members’ psychodynamics, dreams, and feelings. He did not use that ability to avoid looking at his own psychological problems. Despite my encouragement, he would not consider training for professional work as a psychotherapist because he would have had to acquire the necessary academic degrees in medicine or psychology. He is not the only gifted person who has expressed the same hesitations.

Unfortunately, many training institutes do not have a group therapy division, and often those that do have one conduct group therapy in a manner which is quite inadequate. Although this is a major obstacle to the placement of candidates into intensive psychotherapy groups, the existing problems could eventually be worked out.

A second effective procedure would be for the candidate who has been admitted on a conditional basis to bring in the dreams of his patients—together with the notes recording all the associations, feelings, and comments of the patients regarding those dreams as well as the comments and thoughts of the candidate himself or herself. It would allow his or her supervisors to gain a fair picture of the candidate’s aptitudes.

Third: the supervision of the conditional candidate must be on a far more intensive level than is now customary.

The above procedures would be, however, perfectly useless unless the group therapist or supervisor in question was also a sensitive and talented clinical expert. An intellectually and theoretically focused professional will select only candidates who are in his or her likeness.