CANDIDATES’ COUCH
“To plant a garden is to believe in tomorrow.”
—Audrey Hepburn
I have a confession: when I first started my analytic training, I didn't want to become a psychoanalyst. I had just graduated from my institute's two-year psychotherapy program, which I managed to do during my final years of psychiatry residency. I graduated from both at the same time. You'd think that would feel like a triumph. Not for me. Despite my array of certificates, I didn't feel accomplished and ready to cure the world as I'd hoped. Rather, it was as if I'd just devoured an amuse-bouche and was left even hungrier. I would remind myself that I was a bona fide psychiatrist who could now officially claim to be a real psychotherapist as well! Yet these things didn't adhere, and I didn't feel done. Not even close.
I knew the extensive requirements that came with the psychoanalytic training program—though they didn't feel so weighty since I didn't believe I was going to become an analyst. First, I'd have to apply and write an essay. Ok, I could do that. Then there were several interviews. I've done plenty of those too. Things got sticky when I realized I'd have to leave my beloved therapist and start seeing a training analyst. At the time, the list of approved—and available—training analysts in San Diego was unbelievably short. I could count them on one hand. And I already had professional or friendly relationships with many of them, ruling me out as one of their patients. Not to mention, psychoanalysis four days per week with some new stranger was going to cost me at least four times what I'd been paying the therapist I didn't want to leave. Those extra hours meant fewer hours to see my own patients and earn an income.
I'd also have to dedicate essentially one full workday per week to attending seminar courses—even less time to earn a long-awaited, post-medical-training income. Then there would be seeing control cases four days per week, likely at a reduced fee. No part of me whatsoever envisioned myself seeing patients four times a week for the rest of my career. And of course, there would be the accompanying supervision for each case. Slim pickings in this arena too. Less income and less time to spend with my family and for all life's other fun things. Why on earth would I—or anyone—do all this?
Yet, I wanted more. At the time I didn't fully understand why I felt so compelled to start analytic training. Some part of my unconscious urged me to sign up for this nonsensical commitment. I did, of course, have some conscious justifications. I was aware of feeling that I had only a rudimentary understanding of the language and culture of psychoanalysis. I wanted to be fluent. Psychoanalytic concepts were—and still are—infinitely fascinating to me. I craved the intellectual buzz.
Maybe analytic training would boost my confidence in my new role as a private practice psychiatrist too. I sure needed that back then. I was the only psychiatrist in my graduating residency class that started a private practice. This was foreign territory in my program at the time. In fact, I'd spent all of residency downplaying my desire to open a practice whose focus would be psychotherapy. I was silenced by roars of prestige from attending physicians and many peers about careers in research-heavy academia. I feared the mythical community psychiatrist whose isolation spiraled them into the shameful practice of pharmacologic finger-painting. Thus, I lowered the volume of my true psychiatric identity. When the time came, starting a private practice on my own was liberating yet terrifying. Role models were scant. There was no instruction manual. I also needed a part-time job to support myself and my family while growing my practice. All the while, I resisted temptation from recruiters to take full-time, high-salaried yet non-psychotherapy psychiatry jobs. I've half-jokingly said to colleagues that graduating from residency felt more like being a freed hostage. I didn't know what to do with my abrupt freedom. Up until that point, much of my life experience felt akin to marching along well-defined paths to achieve goal after goal. Then, all of a sudden, I found myself at a crossroads—anxiously deliberating the seemingly infinite possible paths. One thing I knew for certain: learning more about psychoanalytic ideas in order to get better at psychotherapy had to remain; and having a private practice was essential in order to do this.
I needed to be thoughtful in my planning of this open landscape. At my feet was a garden to seed that would not mature into a bountiful reality for years.
Coincidentally, around the same time my family and I moved into our forever home that had an enormous, yet barren yard. I have a love for gardening, so this seemingly dismal landscape was a blank canvas for me … for the most part. Again, with seemingly infinite opportunities came more decisions. I had an idea of what I wanted to grow: fruit trees, veggies, some ornamental plants to jazz up the sides of our big box of a house, and of course an abundance of flowers. Yet precisely where, when, and under what environmental conditions to plant each was a conundrum. Clusters of deciduous plants arranged together make for an awfully sad-appearing landscape in the winter when their leaves are gone. I wouldn't want that. Trees which would eventually grow tall enough to block our view would need to be strategically placed. And I certainly needed to figure out how to time my flower-planting for a succession of colorful performances to take place in the summer months. I needed to be thoughtful in my planning of this open landscape. At my feet was a garden to seed that would not mature into a bountiful reality for years.
“In every walk with nature one receives far more than he seeks.”
—John Muir
Once I started analytic training, I changed gears when it came to participating in seminar courses. In the two-year psychotherapy program, my approach to classes had been laden with silence. Psychoanalytic language and concepts seemed so complex and hard to understand. I was convinced that it was surely me who couldn't grasp certain material. When it came to learning psychoanalysis, I finally started to speak up and engage in classes—braving whatever hypothetical ramifications came with doing so—though I had little to lose since my commitment was in limbo. I asked about concepts described in our assigned readings that I couldn't make sense of. It was scary at first. However, I soon learned that intimidating psychoanalytic language is often unhelpful jargon. And, as it turns out, many of my teachers—seasoned analysts—often couldn't make sense of them either! … nor could my fellow candidates! At long last, could we all stop pretending now? My voice grew louder. My opinions grew roots in some areas, yet shape-shifted in others. I dared to disagree with or challenge psychoanalytic concepts. Previously I'd thought my splintering opinions might ostracize me from the psychoanalytic club. I couldn't have been more wrong. Challenging and questioning material in classes truly led to a better education. In turning up the volume of my voice, my psychoanalytic identity finally started to take shape.
To my surprise, I've felt that my voice has been more than merely heard. It has been encouraged to develop. Unlike medical or other professional training, in my experience being a candidate does not equate to a position at the bottom of a hierarchy in which the value of my input corresponds to my standing. Psychoanalytic instructors with decades of experience ask us to actively engage and question things in class. At a national level, candidates’ input and involvement are actually wanted. (Otherwise, I wouldn't have the opportunity to write this article!)
But perhaps my favorite part of weekly seminars has been the company. I've watched my cohort of fellow candidates develop their own burgeoning psychoanalytic identities. We help each other grow. Additionally, we went through the start of the pandemic together—all scrambling to adapt to a new way of treating patients, learning psychoanalysis, and, frankly, living.
And that dreaded transition to starting my personal analysis? Well, it wasn't so bad after all. In fact, it's been one of the most fruitful experiences of my life. My analysis proved tremendously helpful with all those new beginnings early on, and much, much more since then. Over and over, I'd attempt to get my analyst to tell me how I should be doing things to boost my internal report card. Am I actually doing anything? Am I really helping my patients get better? What about my private practice? Is my cancellation policy reasonable? After all, my analyst is also a supervisor. A good one in fact (so I hear). Could he be both analyst and supervisor … and more? Not to mention, he's gone through this training too! But the responses I received to my frantic pleas were always some variant of, “you get to do it however you want to.” For a long time, I couldn't accept this paralyzing freedom. It's simply not true. I'm surely breaking some rule, doing something wrong. Please spare me and just tell me what it is!
Yet, time passed: four 45-minute sessions a week, again and again. Originally on the couch, then—like many people during the pandemic—transitioned to the phone. All the beginnings became middles, and felt like middles too. Roots of confidence began to take hold. Gradually, nebulous repercussions of seemingly wrong choices dissipated from where they'd been shackling my mind. Making mistakes by and large didn't have dire consequences. In fact, I finally learned that making mistakes is inevitable and important. For, making mistakes and learning from them is essential to getting better at anything you do—at being an analyst, managing a practice, being a parent or a spouse, or even the pursuit of creating a masterpiece of a garden. I've come to feel much freer in many aspects in my life. And though it's been several years since I began, it still seems like there's so much more I have yet to see. This psychoanalysis thing, I've learned, is invaluable. Why on earth isn't everyone doing it!
To be fair, there are the ups and downs of acquiring—and keeping—analytic control cases. This part has been hard. How do you convince someone to commit to meeting with you one-on-one for just under an hour, at least four days a week—for years? I could barely commit to it myself! Most people around here don't even know what psychoanalysis is, even many psychotherapists. And this isn't a small town: it's San Diego. So, once I started seeing my first patient in analysis, I was elated. I felt I'd hit the jackpot—someone incredibly self-reflective and curious about their mind. Then, months into treatment, their commitment to psychoanalysis suddenly wavered, as did my confidence. The subtlest of threats to quit analysis from a control case can be devastating to a candidate, as I'm sure others can attest to. With the help of a great supervisor, however, things worked out and I learned from the experience.
While all this growth and discovery was taking place in my psychoanalytic world, another kind of transformation was taking place in my backyard. A little passion-fruit vine I planted early on quickly grew to consume my back fence, producing an abundance of fruit that we now gift to our neighbors and a local café by the buckets each year. Young fruit trees have grown fuller, albeit slowly. The first apples, nectarines, and grapefruits were born. Tomato plants sprout like weeds. Wildflower seeds, planted one year, at first yielded nothing. The following spring, they erupted into multi-colored magnificence. They continue to self-seed year after year without any help from me, while I add new varieties to the mix too. Towering mammoth sunflowers just never get old. In my fantasy, my little flower field will grow bigger, more diverse, and chromatically intensify into a wonderland—rivalling any vibrantly crammed candy shop. Yet year-after-year, much of what gets planted never emerges, or it dies. Pumpkins start, then rot. Dahlias appear, seemingly just to serve as a feast for snails. Our persimmon and pomegranate trees have yet to bear fruit. Maybe next year. I wait, make mistakes, learn new things, try again, and wait some more.
“Gardening is a work of a lifetime: you never finish.”
—Oscar de la Renta
When asked as a child, “What do you want to be when you grow up?”, I would answer, “An archaeologist.” (I was a huge fan of Indiana Jones.) “Psychoanalyst” wasn't quite on my radar yet, though the spirit of long-awaited discovery and joy in solving mysteries were there. Now, decades later, it feels I've found my place, and in way, also my people. It has been personally rewarding to be involved with the psychoanalytic community, and not just here in San Diego. I am discovering the value of engagement with this community outside of my institute.
Importantly, something I came to accept early in this process is that analytic training cannot be viewed as a means to an end—because there is no end. My analytic identity will continue to grow and transform well beyond candidacy. I am not doing this for yet another certificate or credential to put on a resume. (I'm not sure a prospective employer would be impressed, let alone know what it is!) And becoming a psychoanalyst may not result in making a higher income.
Psychoanalysis and gardening are arts: there are endless approaches and few things you can do that are truly wrong or irreparable. Mistakes can be beautiful. It is a passion full of intellectual wonder, trial and error, endless growth, and immense long-term rewards both professionally and personally … and all in good company. I look forward to adding more experience in my pursuit of a more colorful landscape.