The Making of Meaning in the License Qualifying Candidate: Some Experiential Reflections on Training

Justine Duhr, MFA

 

License qualifying (LQ) candidates, a relatively new addition to the field of psychoanalysis, grapple not only with issues inherent in candidacy, but also myriad others specific to individuals without formal education in a mental health-related field.  These candidates are tasked with negotiating the various intellectual, emotional, and practical demands of training without the benefit of a foundation in the field or sufficient acknowledgment of the unique challenges they face.  This paper explores this unique training issue of LQ candidacy and poses the question: what does it mean to be an LQ candidate in the changing psychoanalytic landscape of today and tomorrow? 

 

I am a license qualifying (LQ) candidate.  As I see it, we as members of the field do not yet know the full scope of meaning attached to this designation for the transmission of psychoanalysis and the successful training of analysts.  I remember vividly the moment my analyst realized and articulated for us both the vast distance between our respective training experiences.  I was complaining for the umpteenth time about the multiple and varied difficulties of my training — the frustrations, disappointments, and despairs — when I saw a flash cross her face, an almost imperceptible shift in expression.

 “It just hit home for me now,” she said, “how truly steep your learning curve is, just how much a license qualifying candidate has to contend with.”  I felt immense relief, as if a great load had been removed from my arms, one that I hadn’t fully known I was carrying because no one until that moment had acknowledged it was there. 

An analyst for thirty years with a degree in social work, immersed in the mental health field for the entirety of her professional life — of course she wouldn’t have had immediate access into my experience as a writer-turned-therapist, with no background or prior training in mental health or a related field, trying desperately to navigate a new training, a new practice, a new field, a new way of looking at myself and the world: in many ways, a new life altogether.

My analyst and I, up until that point, had been laboring under the assumption that my current training experience was just as hers had been, unfolding in an intimately familiar, perhaps even nearly identical way, with all the same feelings evoked, the same predictable struggles of candidacy encountered.  And why shouldn’t that be the case? We belong to the same institute, subscribe to the same relational approach, train according to the same tripartite structure — class, supervision, personal analysis — and even study under some of the same teachers and mentors.  But in our tacit agreement (collusion?) that our respective trainings were twin experiences, we had overlooked a fundamental difference, the fundamental difference. More than that, we had failed to recognize the essence of that difference that hung, unobserved and unacknowledged, between us: that I am an LQ candidate and she was not.

The experience of candidacy is substantively different for LQ candidates than for traditional certificate program candidates.  While no candidates are experienced analysts — nor are we expected to be, our training existing largely in service of addressing that lack — many are experienced therapists, or at least identify as individuals who help others professionally. Although contending with inexperience, especially clinical inexperience, and grappling with the uncomfortable feelings it evokes are unavoidable and necessary parts of training, the experience of arriving fresh to a field and cutting a new identity from whole cloth is reserved for one specific kind of candidate, the LQ candidate, who comes to analytic training from a non-mental health-related field.  In this sense, training in an LQ program is a unique experience that, while it shares many challenges in common with a traditional training, also comes with its own unique and substantial difficulties that must be treated as such, for the benefit of the candidates and the future of the field they are preparing to enter.

We have come a long way since Freud published his treatise on lay analysis almost a century ago, in which he famously defends Reik’s right to practice and advocates for the inclusion of non-medical professionals in the field.  Over the past ten years, since the induction by the state of the controversial licensed psychoanalyst (LP) designation, we have seen an influx of such lay analysts in the form of LQ candidates.  Today, with our first LPs five years out of training, and more LQ candidates entering the field with every passing year, the question on our minds is no longer if non-medical professionals should be allowed to practice (although for some more orthodox practitioners, doubts do linger), but rather, what does it mean that we do?  We must now begin to wonder: what is it to be an LQ candidate as separate and distinct from the traditional training experience we have historically known?  “The struggle for lay analysis must be fought through sometime or other,” Freud wrote to psychologist Paul Federn in 1926.  “Better now than later” (Gay 1988, pp. 490-491).  In a way, we are still fighting.

The fundamental difference among LQ candidates and others in experience, background, professional identity, and thus in the tenor and substance of the individual candidate’s training experience, has yet to be adequately acknowledged by the field or by those who practice within it.  To be clear, it is not the case that institutes fail to differentiate between the training requirements of these two types of candidates.  By and large, such extrinsic aspects of training as additional clinical hours and classes are addressed by each individual institute in the way that it deems most fitting and effective.  What is lacking is acknowledgment by our institutes and by the field at large of certain intrinsic aspects of LQ training, a felt experience of the LQ candidate that is conflicted, confusing, and as yet unspoken.  We have put the cart before the horse, so to speak, the state policy preceding the meanings we might, and ultimately must, ascribe.  Thus, for a decade, we have been unable to sufficiently prepare LQ candidates for the full range of their training experience, important aspects of this experience having been felt — and felt deeply —but not fully articulated or acknowledged, and, therefore, left to the candidate to bear alone.

How are we to make LQ candidates feel less lonely and more validated?  How are we to differentiate between the necessary elements of the training experience and the extraneous ones, which are unintentionally damaging and potentially detrimental to a candidate’s education and development as an analyst?  How might we distinguish between a steep learning curve and a too-steep learning curve, one which threatens candidates to fall off the precipice?  How might the (mis)handling of even one unacknowledged aspect of an LQ candidate’s training impact her ability to build a professional identity, first as a candidate and later as an analyst, upon an existing and not necessarily complementary foundation?  How is the LQ candidate to make meaning, in the context of her training, of who she was, who she is, and who she will be?

The question of what constitutes a healthy, desirable, and successful training experience is by no means a new one.  In Still Practicing: The Heartaches and Joys of a Clinical Career (2012), Sandra Buechler points to a problematic gap in training around the building of candidates’ professional identities:

 We don't adequately help candidates bridge what they learn from practice with what they learn from other walks of life. Candidates may come for training already well-versed as parents, teachers, clinicians, supervisors, readers, dancers, musicians, and so on. Too often what we transmit tells candidates to isolate analysis from everything else. Not only does that cut off potential sources of wisdom, but it also encourages the attitude that they have nothing of value to contribute from their own previous and concurrent experience... I think we encourage candidates to act as though they are blank pages, ready to be filled up. They bring nothing of value (p. 13).

Without citing the LQ candidate explicitly, Buechler seems to be calling for a similar kind of acknowledgment of a candidate’s pre-analytic identity in the work.  Our training does not yet and needs to encourage and facilitate a layering of identity and meaning (a message that sounds something like, in my case, “You are a writer and an analyst-candidate both”) rather than a substitution, one for the other (“You were a writer; now you are an analyst-candidate”) — a position that is innately privileging, negating, and ultimately damaging.  “I think this outlook can seriously compromise candidates’ self-respect and the development of a sense of integrity or wholeness,” Buechler continues.  “We all need to bring everything we have ever learned about life to each analytic hour.  Only then do we have any chance of feeling at all prepared” (p. 13).  If a candidate is lucky, she might encounter such an inclusive perspective in one or more individuals — supervisors, teachers, and other senior analysts — over the course of her training, but a field-wide attitude, a unified stance on the relationship between who our candidates were and who they are training to be, and a consistent message about that relationship communicated to candidates both implicitly and explicitly, is still a far way off.

Anthropologist-turned-analyst Victoria Malkin, in an issue of The Candidate Journal devoted to an exploration of power (2010), writes about her struggles in training both as a newcomer to the field and as one of the first lay analysts at her institute.  “At times, I could feel like a traitor, perhaps no longer worthy of this endeavor,” she writes.  “I had come from another profession and was an interloper in a protected space.”  She, too, received an unspoken message, a condition of inclusion that seemed to dictate what she as an outsider could and could not be: “‘Welcome to training,’ the institution of psychoanalysis seemed to be saying, ‘you too will become one of us (if we let you)’” (p. 86; emphasis in original).  Such institutionalized notions about the role of the lay analyst or LQ candidate, and such judgments about the value and relevance of existing knowledge and experience, underlie the problematic training experience of a candidate population that grows larger every year.  Are we blank pages, to borrow Buechler’s metaphor?  Or are we texts in progress, living breathing works being drafted, revised, and refined in perpetuity?  Our institutes are conflicted about how to see us, and thus we are conflicted about how to see ourselves.          

In the days, hours, and minutes leading up to my first-ever analytic session, I was anxious— more anxious than I can ever in recent memory remember being.  Waiting for my patient, I paced the room.  I felt activated and uncomfortable.  My heart was pounding; my palms sweating.  Unsure of how to successfully self-soothe in such unfamiliar circumstances, I drew from what I know: my yoga practice and the art of full, deep, conscious breathing.  I breathed.  I gave myself a series of silent pep talks, working hard to convince myself that whatever happened over the next 45 minutes it would be okay.  But would it really?  I wondered.  What would I do? What would I say?  How should I be?  Would she like me?  Would I like her?  Do such considerations matter?  Would she enter into treatment with me?  Would she not?  And which would be worse?  The list of unanswerable questions and what-ifs seemed endless.  But my primary anxiety, the worry that overshadowed all the other myriad worries, was that she would recognize my inexperience.  As a writer by trade and identity, only a few short months into training, I was terrified of what that inexperience — my perceived and felt un-analyst-ness —might mean about me as an analyst-candidate, now and in the future.       

I had, prior to that first session, raised the issue in supervision.  “What do I do if she asks me how long I’ve been doing this?”  I asked tentatively.  “Just tell the truth,” my supervisor answered.  “You’re a writing coach, so you can tell her that you’ve been helping people for a long time.”

My supervisor’s response is, in many ways, the practical application of Buechler’s call to integrate identity and experience, and also an implicit recognition of the importance of my non-analytic work and the unique perspective I bring to my training.  I felt seen, not just as a person and a candidate, but as a particular kind of candidate: an LQ candidate whose background informs the work in a special way and brings a certain kind of value to the encounter.  I felt relief in this moment, however fleeting — my supervisor’s acknowledgment of the entirety of my selfhood and candidacy doing much to contain my anxiety about who I was and who with my patients I might be.

Those difficult moments before my first-ever session stick with me.  I think about them often.  The experience was intense, confusing, and exhilarating; it was also troubling and hard to bear.  At the same time that I was attempting to calm my overactive mind and body, I held in my mind a sharp awareness about those feelings.  Does everyone feel this nervous? I asked myself. What does it mean that I do?  I didn’t have the answers, of course, and I was at a loss for how I might find them, reluctant to admit to anyone the full extent of my anxiety for fear of what about me it might reveal.  Opening the door to greet my first patient, stepping for the first time into the role of analyst, I might have looked as frazzled and disorganized on the outside as I felt on the inside, an anxious smile pasted to my face — needless to say, a far cry from how I wished to feel or to appear, which of course only added to my suffering.

It did get easier with time and practice as I began to see more patients, ease into my clinical role, and learn to be less self-involved during sessions.  This particular patient, though, proved to be a challenge, strangely fitting to the brand of anxiety I brought to the encounter.  As it turned out, she did ask about my inexperience; it was among her first inquiries, in fact.  She asked about it a lot, in all kinds of ways, some more direct than others.  “It must be hard to know what to focus on,” she said.  “It’s not easy to learn a new skill.”  Over the course of our abbreviated work together (she attended only a dozen sessions before leaving treatment without warning), she was careful not to let me forget my inexperience, no doubt sensing my sensitivity to and discomfort with the topic.  I felt in those moments deeply criticized and shamed, yet later, with some distance and perspective, I felt stronger for the experience.  I had faced my worst anxiety in the form of my patient’s hypervigilance, and lived through it.

Still, I can’t help but wonder how this experience might have differed had there been more recognition of my unique concerns, anxieties, struggles and challenges as an LQ candidate, not only from my supervisor in one small moment and my analyst in another, but also from all corners of my training experience.  Some preparation for the potential impact of my LQ candidacy on my training experience; some recognition of how it might align with and diverge from both fellow LQ candidates’ and traditional certificate candidates’ experiences; some acknowledgment of my particular circumstances as an LQ candidate, would have gone a long way.  I would have still been anxious, no doubt, but maybe not to such an extent.  Perhaps my internal discomfort would have felt more tolerable, more acceptable, my initiation into clinical practice less turbulent. I might have been spared the troubling added layer of anxiety about my anxiety, the feeling of being left alone in that unsettling hall of mirrors.  With some acknowledgment, I might have felt seen, supported, and understood.  Its absence, total or partial, has the potential to unintentionally communicate to the LQ candidate an ambivalence about her status, and perhaps even about her participation in the field.

Despite our progress over the last near-century, is it possible that such gaps in training, certain unattended aspects of LQ candidacy, represent a lingering anxiety about the presence of such candidates in the field?  In our collective failure to acknowledge such fundamental differences, what are we trying not to know?  What are we afraid of facing?  In our eagerness for progress and the introduction of interdisciplinary perspectives, have we perhaps overcorrected, swinging from one extreme to another, from total exclusion to blind inclusion, and in so doing denying the very differences that we claim to value so highly?  And have those anxieties disappeared, or have they merely been transferred from the initiators to the initiated, from the institution to the candidates?  It has become, in effect, the candidates’ burden to bear.  Should it be?            

Much has been written about psychoanalytic training, but not yet training in an LQ program.  I have approached this new subject from the vantage point of my own personal experiences as a candidate entering the field as a writer, simply because that is what I know.  I have attempted to put into words a raw, unarticulated inner experience of a training that has been for me alternately troubling and thrilling, but always stimulating.  I have found doing so important as an entry into an exploration of the wider LQ candidate experience, far beyond the limited scope of my own small self.

I have not attempted to provide answers, but only to raise questions for consideration and contemplation, and to begin to think through these largely unexplored but prominent aspects of the training experience, as well as what meanings we might attach to them.  We do not yet know what the LQ candidate means for training and for the field at large, but perhaps a first step is to acknowledge that there is meaning to be made, separate and distinct from the familiar meanings we have grown accustomed to.  Eventually, we might take a cue from the work itself, to use our newfound understanding of the situation to recognize what we have gotten ourselves into and do the best we can, together, to thoughtfully work our way out of it.

 

References

Buechler, S.  (2012).  Still practicing: The heartaches and joys of a clinical career.  New York, NY: Routledge.

Freud, S. & Strachey, J.  (1969).  The question of lay analysis: Conversations with an impartial person.  New York, NY: Norton.

           Gay, P.  (1988).  Freud: A life for our time.  New York, NY: Norton.

           Malkin, V.  (2010).  On becoming a lay analyst and on doubting a process.  The Candidate Journal 4(1), 79-87.

 

Address correspondence to:

Justine Duhr, MFA
247 W. 76th
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New York, NY 10023
justinetduhr@gmail.com

Justine Duhr, MFA, is a candidate in the license qualifying program at the Manhattan Institute for Psychoanalysis. Her fiction and nonfiction has appeared in the Texas Observer, Publishing Perspectives, The Review Review, Whiskey Island, Fringe Magazine, and beyond.  She owns and operates WriteByNight, a writers’ service dedicated to helping people achieve their creative potential and literary goals.