Christopher Christian, Ph.D., is a third-year psychoanalytic candidate at the New York Psychoanalytic Institute. This institute is home to the tradition of Charles Brenner, M.D., and Jacob Arlow, M.D., whose theories have formed the core of "classical" Freudian thinking, especially the importance of drives and the centrality of the Oedipal complex.

Along with its renown, however, the New York Psychoanalytic Institute has merited the reputation in some circles as the very epitome of analytic insularity: rigid and unyielding in its theoretical outlook, exclusive in its membership, and indifferent to anything outside of psychoanalysis. Yet Christian, who was drawn to the institute in part for its rigor and its emphasis on scholarship, has found the reputation to be unfounded—"a straw man," he said, "for some sort of unified classical view of drives and Oedipal theory, intolerant of different perspectives."

Yet no such unified view prevails, and Christian said the institute teaches a "general science of the mind" that includes a variety of approaches. Of the analytic thinkers that have formed the institute’s reputation, Christian said, "they are classical and orthodox, but they have done much to challenge the concepts that classical analysts once held. They revolutionized psychoanalysis and said things that were considered radical in another age."

Christian might be regarded as one of a new generation of analytic candidates, interested in applying psychoanalytic theory beyond the confines of traditional analytic practice. As part of his training at the institute, Christian attends didactic classes while also undergoing his own analysis. He also has three patients whom he analyzes, with the help of three supervisors. He says his training has enhanced his own practice of psychotherapy and assisted him as well in his special interest of "process research."

Today, psychoanalytic leaders say that training institutes are no longer the inscrutable and exclusive enclaves they once were, or were reputed to be. Opening their doors to people in disciplines other than medicine—psychologists, social workers, and educators—and to the community at large, training institutes have sought to bring analysis out into the open. The very willingness of Christian to speak about his experience at the institute is itself a testament to a kind of candor that might not have been possible a generation ago.

He said that the institute—and the field of psychoanalysis itself—may be to blame to some extent for its reputation of elitism and exclusiveness. While he lauds his teachers, he acknowledges the unusual nature of psychoanalytic training—learning to do analysis by being analyzed oneself. It is a unique teaching method that might seem bound to instill compliance and to perpetuate a kind of theoretical uniformity. All of the thorny issues that emerge in analysis regarding authority and parental figures, he said, become embodied in the very institute whose seal of approval the candidate ultimately seeks.

"Things are evoked in the classes, by your supervisor, and by your patients, and you are talking to the [training] analyst about people that he or she knows.

"And yet," Christian said, "I also appreciate that it does work. You learn that you are not free of the same conflicts your patients are experiencing."

Therein lies the importance of analytic training: the fact that he is himself undergoing an analysis has "made for a richer experience for me and my patients," he said.

Christian sees the future of psychoanalysis in "process research," which he is engaged in at the Glass Institute, a privately funded center for psychoanalytic research in New York City. In contrast to the outcome research coveted by managed care organizations, process research focuses on what happens during treatment—through intense scrutiny of recorded analytic sessions—as a way of discerning what analysis accomplishes, and hence how people change and grow.

He says the current focus within medicine, including psychiatry, on symptom removal, validated by outcomes research, is fated to fail. He cites an eagerness on the part of many patients who have had multiple "short-term therapies" to understand the meaning of their symptoms. "I think the pendulum is going to swing, and that managed care will leave many people dissatisfied," he said.

Yet he acknowledges that psychoanalysis, with its profound emphasis on meaning, process, and relationship, has an uphill struggle against the economic forces favoring rapid removal of symptoms. "For every study that shows psychoanalysis can work, managed care organizations can financially sponsor studies proving that short-term therapies work," he said. "In the end, it’s a big business."