The International Psychoanalytic Association (IPA), formed during Freud's lifetime, is a worldwide organization of psychoanalysts that remained in place throughout the twentieth century. The American Psychoanalytic Association (APsA) was founded in 1911 and grew to three thousand members during the course of the twentieth century. All its members also belonged to the IPA. Many schools for psychoanalysts, or psychoanalytic institutes, were accredited (examined and found to meet a set of standards) by APsA over the years. APsA also developed an examination called certification to test graduate psychoanalysts.
Because the first psychoanalysts in the United States believed that psychoanalysis would be more highly valued if connected with the medical profession, the APsA initially only accepted psychiatrists (who are medical doctors) as members. Exceptions were made for professionals who applied to train as researchers. This contrasted with the practice in Europe, where many nonmedical psychoanalysts became members of the IPA. Nonmedical professionals, such as psychologists and social workers, who wanted to become psychoanalysts in the United States often trained in psychoanalytic institutes not recognized by the APsA. Some were recognized by the IPA and later banded together under the name of the International Psychoanalytic Societies (IPS). Other institutes developed outside both organizations, sometimes creating their own standards for training. By the last quarter of the twentieth century, nonmedical mental health professionals (such as psychologists and social workers) were accepted as members of APsA and grew in numbers, becoming a large proportion of the membership.
Because the title "psychoanalyst" was not protected by federal or state law in the twentieth century, anyone, even untrained persons, could call themselves a psychoanalyst in the United States. Many institutes developed in large cities, such as New York and Los Angeles, that were not connected with APsA or IPS and admitted trainees with varying backgrounds and qualifications. Some of these defined psychoanalysis in their own way, so that arguments developed about the dividing line between psychoanalysis and psychoanalytic psychotherapy. The American Psychological Association eventually developed its own examination to qualify a psychologist as a psychoanalyst.
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