The PANY Bulletin

Psychoanalytic Association of New York
Vol. 40, #2, Summer 2002

New York State Licensure of Psychoanalysts
by Marvin A. Nierenberg, M.D.

As this is written in early July, a bill that will require licensure of psychoanalysts in New York State has been passed by the State Legislature and it probably will be signed into law by Governor Pataki. New York will then join Vermont and New Jersey as states that license psychoanalysts. The same bill also will require licensure for mental health counselors, marriage and family therapists and creative arts therapists and it establishes a scope of practice for each of them. Furthermore, the bill codifies a scope of practice for psychologists and changes that of social workers. What is the history of this development, how will it be implemented and what will the likely impact be on psychoanalysts, the field of psychoanalysis and on the public?

History

For a number of years, bills similar to this one have been introduced annually in the New York State Legislature. Until now, they were defeated by the combined lobbying efforts of members of PANY and other psychoanalytic societies, the Medical Society of the State of New York (MSSNY) and the New York State Psychiatric Association (NYSPA). Each year however, they came closer to passage. There are several reasons for their introduction and ultimate passage:

1. Graduates of some of the numerous psychoanalytic institutes in New York other than those affiliated with the American Psychoanalytic Association wish to be recognized officially as psychoanalysts and, presumably, to be reimbursed by insurers for their services. Many of these graduates are not clinicians. Principally the National Association for the Advancement of Psychoanalysis (NAAP) has represented them and has lobbied on their behalf.

2. Until now, anyone could legally call him or herself a psychoanalyst and practice. Certain legislators are convinced that the public must be protected against unqualified, poorly trained practitioners of psychoanalysis who have been completely unregulated. Licensure and regulation is regarded as an effective way to establish that protection.

3. The New York State Psychological Association has been anxious to obtain what is known as a scope of practice under New York State law that would specify what it’s members would be permitted to do professionally.

4. A law was passed in New Mexico in recent months that permits psychologists to prescribe psychoactive medications after studying appropriate instructional material. It is the only state to have passed such a law, but there is concern that other states may follow suit. The current licensing bill in New York specifically prohibits psychologists and the four newly designated licensed professionals from prescribing drugs, using invasive procedures and obtaining hospital admitting privileges. All physicians, including MD-psychoanalysts, will continue to be permitted to prescribe medications and have hospital privileges, of course.

The confluence of the above factors and events this year led to passage of the bill. The New York State Psychological Association renounced prescribing privileges for their members but gained a codified scope of practice. Psychoanalysts without underlying clinical degrees (medicine, psychology or social work) will be able to become “Licensed Psychoanalysts,” but their institutes must meet defined academic requirements. These requirements are considerably less than those of the American Psychoanalytic Association however.

Implementation

If as expected, it is signed into law, the bill will become effective in January 2004. After that time, those practicing psychoanalysis must either be licensed as physicians, psychologists or social workers or they must apply to become a Licensed Psychoanalyst. While any licensed physician, psychologist or social worker may additionally apply to become a Licensed Psychoanalyst, it will not be necessary for him/her to do that. They will be regarded as exempt professionals, that is, exempt from the requirement to be a Licensed Psychoanalyst in order to practice that profession. Only those who apply for and are licensed as psychoanalysts will be permitted to call themselves Licensed Psychoanalysts. Others may only call themselves psychiatrists, psychologists or social workers and psychoanalysts.

Clinical graduates of institutes of the American Psychoanalytic Association who are not licensed clinicians (those who were trained under provisions of the Committee on Research and Special Training—CORST) will have to apply to become Licensed Psychoanalysts in order to practice in New York..

In order to be a Licensed Psychoanalyst, an individual must have a master’s or doctoral degree (in any field), must have been trained in an institute that is registered or chartered by the State Education Department and must pass an examination (with certain exceptions). This provision of the bill is expected to provide a minimum or floor of standards for all psychoanalytic training institutes. It is clearly less than that of the American Psychoanalytic Association.

Impact on Psychoanalysis

What will this mean to those PANY members who are clinicians, have been practicing and teaching psychoanalysis and to those who will be doing so in the future? Since under this bill, they will legally be permitted to practice psychoanalysis, they will probably continue to work, teach and study much as they have in the past. Some may choose to apply to become Licensed Psychoanalysts, but what additional value that might have is unclear. How many might apply for this additional license is unclear.

CORST graduates will be required to become Licensed Psychoanalysts. To become licensed they must pass an examination unless they are either certified by the American Psychoanalytic Association or have been in practice for 5 of the past 8 years. There is some ambiguity in the bill on this point.

The new bill will enable non-clinicians who have been trained at psychoanalytic institutes that have lower standards than those of the American Psychoanalytic Association to become Licensed Psychoanalysts in New York State. Many of those psychoanalysts have been practicing without the benefit of licensure or clinical training. At least this bill will impose a basic minimum of standards on their institutes in the future. It is unclear whether this will substantially affect the standards of training and practice or not. It has been feared that licensing non-clinician graduates of less rigorous training institutes would lower these standards for the entire field. It is possible that by first applying minimal standards, the state will eventually improve the educational requirements for all psychoanalytic training institutes and their graduates.

It is doubtful that many among the public will understand and appreciate the difference between those who practice psychoanalysis under their scope of practice as clinicians and those who will become Licensed Psychoanalysts, clinicians or not. As it is, many people don’t understand the similarities and differences among psychologists, psychiatrists and psychoanalysts. This bill may only confuse the public more than it already is about these matters.

In any event, it appears that the conditions for psychoanalytic practice and training will undergo change as this bill becomes law and is implemented. The nature and extent of these changes remain to be seen.