Doctor Debate: Still Talking About Titles

The Doctor Debate: Still Talking About Titles

Flora E. Lazar, PhD LCSW

The American Psychoanalyst
Volume 55, No 2, Spring/Summer 2021

In this article for The American Psychoanalyst (page 7), Flora Lazar revisits a sensitive topic in psychoanalytic history — what is the necessary academic preparation for training/practice in psychoanalysis? She traces the history and controversy about degrees in the field and argues, from a self-psychological perspective, that degrees may have more meaning to clients/patients than to clinicians.

Doctor Debate: Still Talking About Titles


Perhaps because I grew up in a family of medical doctors and I was the only one to earn a PhD, the prospect of being mistaken as a member of the MD club seemed fraudulent. After all, my hard-earned doctorate was academic not clinical. I often disguised my degree dysphoria under the guise of alliance building, asking patients in the first session how they would like to be addressed and routinely informing them that I referred to myself by my first name. How they referred to me was their choice. Occasionally, a patient would discuss why he or she had selected me as a therapist, admitting that they did not really know what to make of all the different letters after therapists’ names. If they went so far as to inquire, which some did, about the significance of varying degrees, I offered a brief explanation of the different pathways to clinical work, only occasionally getting far enough into the weeds to explain how some-one with a PhD could also be designated a student intern for clinical purposes. …

For years, I found the obstacles to communicating about my academic and clinical background unsettling verging on fraudulent. Only over time and with greater clinical confidence have I come to realize that being a “doctor,” even a “doctor of philosophy” as my PhD denotes, actually does have clinical value. But unlike what Epstein would have us believe, the value is less for me than for the patient. As Bruce Wampold, “an exponent of the common factors approach to psychotherapy efficacy research,” and others who subscribe to the “common factors” approach to psychotherapy have underscored, expectations of being helped play an important role in effective psychotherapy outcomes. Realizing that patients who are suffering and seeking help have a need to call me “doctor,” even the wrong kind of doctor, more than I have need to be called one, has helped me settle more comfortably.