Psychoanalytic Psychology and the Academy: Identifying and Addressing the Growing Crisis

by David Ramirez

Among those contemporary college students who seek counseling—and despite their heterogeneity along lines of class, culture, race, gender identity, and sexual orientation—most share similar experiences of discomfort, distress, and a desire for relief. Something’s not right in their life, and it’s taking a toll: interfering with simple pleasures; undermining productivity; compromising functioning; obstructing relationships; causing, in some cases, thoughts of suicide and/or self-destructive behaviors like heavy alcohol- or drug-use and cutting. Moreover, many of them tend to perseverate on certain existential questions: What am I doing? Why am I here? Whose life am I leading? How do I know what I really want?

Clinical symptoms and the life-stories in which they’re embedded are often enmeshed with traumatic experiences, whether recently occurring or carried from the student’s earliest years. Other commonly observed factors include students’ experiences of poverty, racism, parental divorce, failed relationships, illness, and loss. Presenting symptoms and the conditions that give rise to them pose many challenges for the recognition, naming, and treatment of each student-client’s particular disorders. Formal psychiatric diagnoses are crucial to the process of assessment and necessarily serve as the currency of communication for such challenges as anxiety, depression, and PTSD. However, these diagnostic labels can also obscure or discount both the full nature of the student-client’s suffering and the conditions that generated and perpetuate it.

Psychodynamic Therapy Works

In the U.S., college counseling centers have traditionally provided “talk therapy” as a primary modality that has been shown to be effective in addressing student-clients’ needs. Clinical practitioners of talk therapy must have specific listening and organizing skills, which are acquired through different forms of didactic and experiential education (e.g., practica, internships, and residencies) and grounded in the theories and techniques of recent and contemporary psychoanalytic psychology.

Therapists trained to provide talk therapy commit themselves, above all, to listening in an intentional way, both to the student-client’s words and to the emotional timbre of their speech, including any absence of emotional resonance. As psychologist Earl Koile puts it, “our sense of identity and part of our nature as human beings hinge on our ways of talking and listening to” one another (21). While listening to their student-clients, analytically oriented therapists also listen to themselves, both at the cognitive level (What are the therapist’s thoughts?) and at the visceral level (What’s happening in the therapist’s body?).

The therapist’s experiences facilitate their understanding of the student-client’s experiences. This “two-person” (or “interpersonal”) model makes psychodynamically oriented therapy distinct. Other modes of talk therapy often don’t consider the therapist’s experience as an important source of data about the client and the progress of therapy, which can have the effect of compromising the potential power of the therapeutic alliance. Students are quite attuned to the quality of their experience with their therapist, able to assess both the trustworthiness of the process and of the therapist. The quality of this dynamic collaboration can make the difference between wholehearted participation and reluctant engagement.

Therapists in college counseling centers are in a unique position to offer students something unavailable to them anywhere else on campus: the opportunity to speak openly and honestly about what’s troubling them with an attentive, non-judgmental interlocutor in a confidential, therapeutic space that’s free of the demands and pressures to perform that characterize classrooms, labs, and playing-fields. Time spent with the psychotherapist is devoted to sustained appraisal of the distress presented by the student, as well as to the impact of the questions posed and the reactions offered by the therapist. At its best, the process is fluid, iterative, and adaptive to the needs of the student.

But This Takes Time

Before the dramatic increase in demand for student Counseling and Psychological Services (CAPS) in the 2000s, psychotherapists could greet students with the simple question “So, what brings you to CAPS?” and know that they would be able to work with the student on a weekly basis—the only restrictions being those of the academic calendar. Working this way allowed for the emergence of critical concerns at whatever pace best suited the student and also gave the student the time they needed to take the measure of their therapist and to build a trust-based relationship.

Prior to the early 2000s, usage statistics were reliably stable: the most frequent number of visits per student was one, meaning that these students’ needs were met in just one visit. Half of all students utilized 5-6 visits, while the overall average of 8-9 visits encompassed the full range, from a single session to as many as 35 sessions in an academic year. And, up until about ten years ago, counseling centers typically served roughly 25% of enrolled students. Over the past decade, however, utilization patterns remained relatively constant, while the percentage of students served swelled to more than 40% of enrolled students—a dramatic increase that helped precipitate the urgent situation counseling centers find themselves in today.

Although many counseling centers still tried to offer a holding environment for students for as long as needed, the availability of this paradigm for therapy was dramatically reduced—notwithstanding the fact that the efficacy of the talk-therapy model is clearly supported by psychologist Martin Seligman’s 1995 study of the so-called dosage/response effect. Seligman’s study found that talk therapy worked as well as medication for many symptoms and that more talk therapy worked better than less. Because Seligman is an academic psychologist not usually associated with psychoanalytic psychology, his study’s empirical confirmation of the dosage/response effect stands out as a particularly unbiased affirmation of core tenets of psychodynamic psychotherapy. Fifteen years later, Jonathan Shedler re-affirmed Seligman’s findings in his own study of the efficacy of psychodynamic psychotherapy.

And Time Costs Money

As the number of students requesting help from campus counseling centers has grown exponentially, institutions’ commitment of financial resources has failed to keep pace. Over the past decade, a few wealthy colleges and universities responded tentatively by adding some new staff—but never in sufficient numbers. A more common response to the exponential increase in demand was a shift away from psychoanalytic or psychodynamic psychotherapy—which emphasizes development of insight in service of problem resolution—to treatment modes that prioritize targeted symptom alleviation and minimize or ignore causation.

Symptom relief is vital—especially for students in crisis. But targeting symptom relief in the absence of talk therapy yields, at best, temporary fixes and leaves underlying disorders and conflicts untreated. It takes time for the student-client’s story to unfold in dialogue with the therapist so that, together, they can better understand the place and meaning of the symptoms in the student’s experience, which holds out the best hope of managing and even overcoming the root causes of their most profound forms of pain and suffering.

Short-term therapies can be quite helpful in situations of well-defined difficulty and an absence of co-morbid mental-health and situational compromises. But they fail to take into account the specific—often critical—needs of their student-clients in relation to aspects of their life-experience that require time and patience to explore and understand and that span the full range of psycho-social factors, from early-childhood trauma to poverty, racism, homophobia, misogyny, and—quite often—a sense of betrayal by the very institutions charged with protecting and nurturing them, including hospitals, police, courts, banks, and even the colleges and universities they pay to attend.

Even elite colleges and universities—including, for example, the University of Pennsylvania, Swarthmore, Bryn Mawr, Haverford, St. Joseph’s, Amherst, Williams, Brown, and Princeton—appear hard pressed to reconcile tensions between students’ need for readily available psychotherapy and the high cost of providing it. Funding priorities would have to be substantially reordered to make available to today’s students the kind of therapy that was the “industry standard”—at least at these elite institutions—in the 1990s. Indeed, there seems to be an increasingly deeply entrenched mindset within the upper administrative echelons that the kinds of resources made available for teaching and research simply cannot be made available for the psychological, emotional, and developmental needs of their complex, multicultural, heterogeneous student bodies.

Funding priorities and the philosophical principles they reflect ultimately emanate from distant and frequently ill-informed governing bodies such as Boards of Directors and state legislatures. On the ground, the overworked and underfunded leaders of counseling centers are left without the resources or the public support to meet distressed students’ overwhelming need for resource-intensive talk therapy to recover the full use of their minds and spirits. Anecdotal reports of a significant increase in the number of counseling center directors resigning and retiring may reflect a widespread sense of futility regarding this inability to provide students with quality professional care.

From the vantage point of a psychologist who has worked at UPenn, Haverford, and Swarthmore, the situation is growing evermore dire. All readers of this post—students, clinicians, faculty, and administrators—are encouraged to respond with stories from the frontlines and suggestions for restoring essential services. Current undergraduates, especially, are warmly invited to chime in and to share stories and information about the situation at their own institutions. Reader, your thoughts about the mental healthcare crisis in U.S. higher education?

 

Works cited

Koile, Earl. 1977.  Listening as a Way of Becoming. Waco: Regency Books.

Seligman, Martin E. P. 1995. “The Effectiveness of Psychotherapy: The Consumer Reports Study.” American Psychologist 50.12: 965–974.

Shedler, Jonathan. 2010. “The Efficacy of Psychodynamic Psychotherapy.” American Psychologist 65.2: 98-109.

Child’s Play at APsaA: Discovering Psychoanalytic Play Therapy

by Esha Bhandari

Starting college, I thought I had everything figured out. I was going to study the social sciences, enlist myself as a research assistant in a few of my university’s psychology research labs, and then eventually I’d get my Ph.D. and begin my life as a clinical psychologist. By my junior year, I had taken nearly every psychology course that was offered at my university—courses that spanned what I thought was every field in the discipline, including social psychology, clinical psychology, cognitive psychology, developmental psychology, cultural psychology, educational psychology, psychology and the law, and community psychology.

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Making “Black Psychoanalysts Speak”

by Basia Winograd

[Note: Director Basia Winograd’s 2014 documentary, Black Psychoanalysts Speak (which can be screened via YouTube, here), is required viewing in many of the undergraduate courses that I and my colleagues teach in the Psychoanalytic Studies program here at the University of Pennsylvania and in many such courses at other colleges and universities throughout the U.S., Canada, and the U.K. Whether our students are interested in psychoanalytic theory or in the history of psychoanalytic practice, they find that this splendid film answers many of their questions about the changing face of the profession and the changing terms of clinical and metapsychological discourse. What is the place of race in analytic thought and practice? Why are there still so few African American psychoanalysts? And what do they have to say about their own professional formation and about the extent to which discussions of race and related sociopolitical, cultural, and intergenerational experiences have been, until recently, virtually excluded from the analytic consulting room? My own students continue to be both dismayed and encouraged by the stories they hear from the analysts Winograd interviews in the film—stories of institutional and personal racism, stories of patients whose experiences as African Americans are routinely ignored or dismissed, and stories of gradual but meaningful change. Because Black Psychoanalysts Speak features in so many contemporary undergraduate courses on psychoanalysis, I’ve asked Basia Winograd to tell the readers of Psyche on Campus a bit about the making of the film and about the relation between cinema and psychoanalysis from the filmmaker’s perspective. Happily, she’s agreed!  —Max Cavitch, editor]

As a documentarian, I’m often approached by someone convinced they know what my next film needs to be. Almost invariably, the project they have in mind is the moving portrait of an organization grappling with one of our civilization’s most pressing problems: climate change, poverty, gender inequality, racism, etc. I hate to sound cynical, but I’ve learned over time that such “films” rarely turn out to be more than vanity projects: fundraising videos disguised as art. I understand the need for fundraising, and I’m as terrified as anyone about all the world’s current and impending cataclysms. But let’s keep our categories clear. I went to film school. I know what a film is.

Thus, when I was approached in 2013 by a group of Black psychoanalysts searching for a filmmaker, I had my doubts about getting involved. At the time, I had only the vaguest notion of what a psychoanalyst was. Kind of like a psychologist, I thought, but maybe more eccentric? Maybe even a little perverse? I have plenty of admiration for mental health practitioners, but also a strong suspicion of anything that smacks of eurocentrism…like a universal theory of human behavior developed by a cigar-smoking middle-class doctor in turn-of-the-century Vienna.

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Loving Yourself Workshop: A Poem

by Susan M. Schultz

According to a JED Foundation Survey published October 22, 2020, eighty-two percent of college students deal with anxiety, sixty-eight percent with depression, and one in five (nineteen percent) of students have had suicidal thoughts in the past month. In bold print, the report asserts, “Mental health should be a top priority for schools.” I have spent the past seven years advocating at the University of Hawai`i-Mānoa for better campus mental-health services. If you read recent press releases from UHM, you would think these services had improved dramatically. But if you pay closer attention, you will hear the hollowness of the language of care. In fact, even as the rhetoric improves, the level of care diminishes.

Thus begins my essay, “The Language of Care in (My) Neo-liberal University,” which is based on a talk I gave at the recent Webinar Colloquium, “Poetics and the University in Crisis” (March 3-5, 2021). My argument—based on many years of activism at the University of Hawai`i-Mānoa (UHM)—was that the university, in its response to demands for better mental health care, gave only the semblance of actually caring. Communicating a public message of ‘care’ fulfills the university’s public relations priorities while downplaying its unwillingness to spend the money that would be needed to strengthen the Counseling and Student Development Center. It was one more sign, sad to say, of the university’s overall unwillingness to revive the notion of the university as a community of care.

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Discovering Psychoanalysis as a Business School Student

by Ryan Collins

My exploration of psychoanalysis began with philosophy. Like many people my age, I was seeking answers to certain existential questions: “Who or what governs our behaviors, and are they rational?” Philosophers—from Plato, Aristotle, and Marcus Aurelius to Descartes, Hume, Kant, and beyond—have been asking similar questions for millennia. Although he was not a philosopher, Freud’s founding of psychoanalysis tackled such questions as well. While many of his theories have been challenged and revised, his discovery that our behaviors are often governed by unconscious conflicts between our desires and internalized societal demands remains relevant today. Although Freud continues to be a controversial figure, he critically challenged our belief in human rationality by demonstrating the unconscious and “irrational” nature of most of our behavioral tendencies.

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“Psyche on Campus” Named One of the Top Ten Psychoanalysis Blogs to Follow in 2021!

Thanks to our thousands of readers and subscribers around the world, “Psyche on Campus” has been chosen as one of the “Top 10 Psychoanalysis Blogs You Must Follow in 2021” by Feedspot. You can see the full list here: https://blog.feedspot.com/psychoanalysis_blogs/

Subscribing to the blog is free–just click the “Subscribe” button in the bottom right corner of your screen.

And remember: If you have an idea for a post of your own, just let us know by writing to: cavitch@english.upenn.edu.

 

Psychoanalysis as Argo: A Podcast Setting Sail in the Virtual Classroom

by Anneleen Masschelein and Yael Segalovitz

It was June 2020, about two months into the whirlpool, which—we then had no way of knowing—would swallow up our lives for many more months to come. In Israel, Yael was at home with her two young boys (who couldn’t fathom why the playgrounds were empty and cordoned off by yellow tape), rushing to meet the deadline for an article on autotheory and psychoanalysis. In Belgium, Anneleen was in a similar situation: torn between the demands of her child, her teaching, and her research during the early stages of what would become a seemingly endless lockdown.

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Teaching Psychoanalysis with Children’s Literature *

by Lawrence D. Blum

I’ve designed a syllabus for a novel way to teach basic psychoanalytic principles and child development. Although originally developed with undergraduates in mind, a course based on this syllabus has been taught with great success to candidates at the Psychoanalytic Center of Philadelphia by my friend and colleague, Dr. Susan Adelman. I’m posting here about the course both to encourage others to use it as the basis for possible courses of their own and to solicit from readers (students and teachers alike!) suggestions for improving or expanding it.

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Teaching Winnicott: On Listening and More Than Listening

by Jordan Alexander Stein

We teachers don’t always know how to walk the line separating the pedagogical from the extra-pedagogical.  Years ago, when I was fairly new to the job, I found myself in office hours listening to a student in some amount of pain.  I gave her a hearing, brokered an accommodation, and sent her on her way.  But as the day went on, I began to fret that I hadn’t done enough––that I could and should have been more encouraging, or at least told her I recognized the bravery that comes with asking for help.  So I turned to friends for advice, and one memorably emailed to say “Therapy is 95% listening and 5% things you’re not qualified to do.”  Their point was that, in doing no more than listening, it may well be that I’d done enough.

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Impossible Professions: Teaching Literature and Psychoanalysis

by Emma Lieber

In “Analysis Terminable and Interminable,” Freud famously claimed that psychoanalysis is one of the three “impossible professions”—the others being education and government. The recent political environment in America certainly gives us a lens onto the impossibility of the latter, and perhaps what “impossible” means in these contexts, though the high drama of the Trump administration may also obscure what’s at stake. What is the aporia—the irreducible, unassimilable gap—at the heart of these vocations? What are their desires and aims, and what within them challenges, not so much the achievement of those aims, but any conventional notion of what achievement means? In what way do these pursuits underscore what Lacan for one designates as the impossibility of desire? And how might recognizing the impossibility of these endeavors influence the aims and techniques of their practitioners?

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