Culture of/Market for Psychoanalysis in NYC vs. rest of U.S.

[Lexanoob]

Hello! I'm a resident at an NYC program and am considering pursuing training in psychoanalysis after residency. I've noticed differences in psychoanalytic training in NYC vs. in other cities, and have a few questions:

1) Is there any benefit to pursuing training at a program in NYC (where we have seemingly a large variety of psychoanalytic institutes with various different slants) versus at some other institutes in other cities of the U.S. What does this mean with regards to differences in training/ is it preferable to pursue training in NYC versus at institutes in other cities?

2) Additionally, some have mentioned that the only realistic market available for having a full-time job where you only do psychoanalysis is only in NYC, where people have cited a rate of at least $450/h per session. Would appreciate if any one can comment on the market for psychoanalysis anywhere else in the U.S.!

Thanks so much!

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[notamindreader]

The benefit of pursuing psychoanalytic training in NYC is that the network of psychoanalysts there is quite robust and probably the most dense in the US. If you are seeking affluent patients to fill a psychoanalytic practice, having connections and referral streams for wealthy Manhattan folks will quite helpful. However, Boston and San Francisco are similar in this respect, and you will be able to find strong psychoanalytic training programs outside of those 3 cities. Austen Riggs and Emory are both exceptional, and in reality you can find excellent training both here in the US and abroad (think of going to Paris, Montreal, Buenos Aires) if you are seeking Lacanian focused training. Regarding having $450/hr sessions 4-5 times a week, consider that that is a very particular niche. Even seasoned teaching analysts in more affluent cities like NYC, Boston, SF charge rates in the $200-350 range if they are seeing someone multiple times a week. If the analyst knows that the patient can afford much higher rates, then so be it, but I think that this is an exception rather than the norm for usual practice. Consider that where you practice will influence your rates in this respect. Bear in mind that training analysts are usually required to take low fee cases, and so hopping on the gravy train will take a many years at least. Due to the intensity of the work, most psychoanalysts I've met do not see 30+ clinical hours per week, but rather spend a mix of their time reading, writing and lecturing.

 

[dl2dp2]

I have a peripheral interest in this field--I think COVID might change things in this area. e.g. the availability of Livestream video overhead could in theory allow a wealthy patient to be an analysand anywhere in the world. In particular, given that these are non-insurance-reimbursable services anyway, it's more about having the right marketing plan.

In particular, I'm not sure the older analysts are good models. They often don't have EMRs. I am also deeply suspicious of the utility of actual "analytic training" in the potential of building a real analytic practice, as I have known people who never completed the training who became successful in building such a practice. For example, I suspect most of the therapists well-trained in TFP can do classic psychoanalysis without any issue.

 

[Marasmus1]

I have been training in psychoanalysis and on psychoanalysis myself 4 times a week. My analyst is a big name in NYC and charges sliding scale.

In my honest opinion, if you do not have crazy personal interest to the field, I would not waste my money with the training and personal analysis. I started just out of curiosity and planning to quit next year. I am not seeing this a long term practice option as the demand for psychoanalysis has been dying out. Most of the theories are fascinating yet not much applicable to the way psychiatry is practiced nowadays.

 

[NewYorkChildPsych]

New York is a predominately psychodynamic city, although the number of psychiatrists practicing classical psychoanalysis seems to be declining.

Many of us early career faculty in NYC, regardless of our particular subspecialties within the field, are at least interested in psychoanalytic theory: how it began, how it evolved, and the core concepts that still resonate today. I have taken courses part-time at one of Manhattan's psychoanalytic institutes, and they have been fascinating and enriching.

There are excellent programs elsewhere of course, with passionate people running them. You can pursue a psychanalytic fellowship at Austen Riggs (2-4 year program, post-residency, where you're essentially a trainee paid at resident/fellow salary) in Stockbridge, MA, or part-time coursework at any number of programs. They're all over: Chicago, SF, Boston, and New Haven... among so many others.

Where there are psychoanalytic institutes, there are psychoanalytic markets.

 

[WisNeuro]

Is there any market research on the demand for analysis? Genuine question. I am not aware if any market for other treatment modalities either, so I doubt it, unless there is some small survey done by a guild organization. But, anecdotally, I don't really question the market for things like DBT, as most places I've worked, we struggle to place people who need such treatment due to lack of qualified providers and long waiting lists. But, even in my years on local practice listservs, I can't recall anyone ever asking for a referral for analysis. Just curious if there is some other info out there.

 

[psychacad]

There will always be a market for people with too much time on their hands who want to explore their life story with a professional. It's a niche but I think it's there. You can't replace prolonged contact. Nowadays analysts don't pretend that analysis is the be-all treatment in psychiatry and it's specifically advertised for decent functioning adults who want to understand more about their lives and correct some self-defeating patterns.

People have been predicting the death of analysis for two decades now. PDT is as popular as ever, and analysis is essentially the well for PDT. TFP and MBT were both created by analysts if I'm not wrong (kernberg and fonagy respectively) and you can't have one without the other.

From my personal experience I found that there's a well of thought and experience in analysis that is extremely useful in how one approaches patient care. Might be an interesting time to go in the field, as basically the unconscious ain't going anywhere.