SDPC Psychoanalytic Training Admissions Application

APPLICATION FOR ADMISSION TO THE PSYCHOANALYTIC STUDIES PROGRAM
Thank you for your interest in the San Diego Psychoanalytic Center's (SDPC) Psychoanalytic Studies Program. We are delighted you're exploring this opportunity to deepen your understanding and practice of psychoanalysis.

Our program offers a dynamic and supportive environment for rigorous academic study and clinical training, led by experienced faculty dedicated to fostering intellectual growth and professional development.

If you have any questions or would like to learn more about the application process, program structure, or upcoming events, please don't hesitate to reach out. We're here to support you on this journey.

To read more about the program, go to: sdpsychoanalyticcenter.org.

We look forward to welcoming you to our community of learners and practitioners.

-SDPC Admissions Director, Kristin Whiteside, Ph.D.

Please click arrow for a list of documents needed prior to completing this form.
Please be prepared to provide the following information with your application. Please note that the application system will save your input as you proceed, allowing you to return later to complete it at your convenience

(1) A recent photograph.

(2) Autobiographical Essay (typed) to include the significant events of your life and the significant steps in your career, including any experiences and relationships that you consider important factors in having interested you in psychoanalysis.

(3) Application fee:
- $125 (2-year program)
- $250 (5-year program)
(4) Case Summaries:

A. IF APPLYING FOR CLINICAL TRAINING:

5-year Psychoanalytic Track: Summaries of two adult cases, preferably one male, one female, which show your diagnostic understanding of the patient and the process of therapy, to be used as a basis for presentation to members of the faculty. Each summary should not exceed ten double-spaced typewritten pages. There will be four interviews with members of SDPC faculty, which will be arranged upon receiving applications.

2-year Psychoanalytic Psychotherapy Track: Summaries of one adult or child case, which show your diagnostic understanding of the patient and the process of therapy, to be used as a basis for presentation to members of the faculty. The summary should not exceed ten double-spaced typewritten pages. There will be two interviews with members of SDPC faculty, which will be arranged upon receiving applications.

B. IF APPLYING FOR ACADEMIC TRAINING, NO CLINICAL SAMPLES ARE REQUIRED. ACADEMIC TRAINING IS FOR NON-CLINICIANS ONLY.

(5) Signed and dated Authorization and Release form. We will request letters of reference from training institutions, training programs, or supervisors.

(6) Copy/photo of license to practice.

(7) Copy/photo of diploma(s).

(8) Proof of malpractice insurance.

(9) Three letters of reference. Please have reference letters emailed directly to the Director of Admissions, Kristin Whitside, PhD.

ProgressBar
Application for Psychoanalytic Studies Program
Please indicate the Psychoanalytic Studies track for which you would like to apply:

2-year Psychodynamic Psychotherapy5-year Psychoanalysis
Are you are applying for the 5-year program clinical or academic training (no control cases)?

Clinical TrackAcademic Track
Do you intend to additionally pursue training in child and adolescent psychoanalysis?

YesNo

Personal Information
Name*

First NameLast NameTitle
Email*
example@example.com
Mobile Number*
Please enter a valid phone number.
Website
Other (Linked In, Social Media)
Please upload a recent profile photo

Cancelof

Address

Work Address
Office Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work Phone
Please enter a valid phone number.

Home Mailing Address
Home Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone
Please enter a valid phone number.

Education
A. Please list undergraduate school name(s), date of graduation, major, honors

Medical School
B. Please list medical school name(s), degree, date of graduation, major, honors
Residency (type)
Psychiatric fellowships
Other

Graduate School
C. Please list graduate school name(s), degree, date of graduation, major, honors
Clinical Internships
Please list your clinical internship(s) with the following details: setting (hospital, outpatient clinic, etc.), activities and responsibilities (psychological testing, individual psychotherapy, etc.), population and theoretical orientation of supervision (psychodynamic, CBT, etc.).
Postgraduate Training
Please list your postgraduate training experiences with the following details: setting (hospital, outpatient clinic, etc.), activities and responsibilities (psychological testing, individual psychotherapy, etc.), population and theoretical orientation of supervision (psychodynamic, CBT, etc.).

Academic Diplomas
Upload a photo of all academic diploma(s)

Cancelof

Licensure & Certification
License (State and Number)*
Upload a copy of your California license/registration to practice including date and number. If reporting a registration number, please indicate the name of the supervisor under whose license you may practice:

Cancelof
Malpractice Insurance
Malpractice Insurance Company Name and Policy Number
Please upload a copy of your malpractice insurance:

Cancelof

Curriculum Vitae (CV)
Please attach your CV here. Please include clinical, teaching, and supervisory experience, publications, and professional memberships.

Cancelof
Current Clinical Practice
Current clinical practice: estimate number of patients treated per week, typical length of treatment, typical problems that are treated and the number of hours per week in clinical practice of psychotherapy.
Teaching Experience
Describe your experience developing curriculum and/or teaching.
Supervisory Experience
Describe your experience providing clinical supervision.

Membership in Professional Organizations or Societies
List membership(s) in any professional organizations.
Other Certificates
Upload any additional certificates or diplomas held (e.g. Board certificates) :

Cancelof

Professional & Ethical Practices
Professional and Ethical Questions
If you respond yes to any of the below questions, please explain.
1. Has any governmental authority, health care facility, group practice, professional society or association, or academic or educational facility brought charges or a complaint against you or imposed any discipline against you relating to your practice or professional conduct, including for any alleged violation of laws, rules, by-laws, standards of practice or ethics?*

YesNo
1a. If yes, please give details:
2. Within the last 5 years, have you ever resigned, been suspended, or excluded from the staff of any hospital or professional organization because of problems related to loss/restriction of privileges?*

YesNo
2a. If yes, please give details:

Professional & Ethical Practices...
3. Has your license to practice as designated above ever been revoked, suspended, or limited? If yes, please give details:*

YesNo
3a. If yes, please give details:
4. Have you withdrawn an application for a professional license or been denied a professional license for any reason?*

YesNo
4a. If yes, please give details:

Professional & Ethical Practices...
5. Have you ever been convicted of a felony, or have you been convicted in the last ten years of any misdemeanor or other criminal offense, other than a minor traffic violation or are you currently charged withany criminal offense?*

YesNo
5a. If yes, please give details:
6. Has any professional liability insurance provider restricted, limited, terminated, imposed a surcharge or co-payment on, or placed any condition related to professional competency or conduct on your coverage or have you voluntarily restricted, limited or terminated your insurance coverage in response to an inquiry by a professional liability insurance provider?*

YesNo
6a. If yes, please give details:

Professional & Ethical Practices...
8. CLAIMS MADE: Has any malpractice claim been made against you that has not yet been finally settled or adjudicated, whether or not a lawsuit was filed in relation to the claim?*

YesNo
8a. If yes, please give details:
9. CLAIMS RESOLVED: Has any malpractice claim that has been made against you been settled, adjudicated, or otherwise resolved, whether or not a lawsuit was filed in relation to the claim?*

YesNo
9a. If yes, please give details:

Professional & Ethical Practices...
10. Has any lawsuit, other than a malpractice suit, which is related to your competency to practice, or your professional conduct in the practice of your discipline, been filed against your or been settled, adjudicated or otherwise resolved?*

YesNo
10a. If yes, please give details:
11. Has your privilege to possess, dispense or prescribe controlled substances been suspended, revoked, denied, restricted by, or surrendered to any state or federal agency?*

YesNo
11a. If yes, please give details:

Terms and Conditions
Signature

Clear
Date

MonthDayYear
Date

Personal Psychoanalysis and/or Psychodynamic Psychotherapy Experience
Have you had previous and/or current experience in Psychodynamic Psychotherapy and/or Psychoanalysis?*

YesNo
Previous Psychoanalysis and/or Psychodynamic Psychotherapy Experience
Please list any previous training in this and other psychoanalytic training programs (including dates):

Case Summaries
5-year Psychoanalytic Track
This summary should not exceed ten double-spaced typewritten pages.
1. 5-year Track: Please include summaries of two adult cases, preferably one male, one female, which show your diagnostic understanding of the patient and the process of therapy, to be used as a basis for presentation to members of the faculty. Each summary should not exceed ten double-spaced typewritten pages.

Cancelof

2-year Psychodynamic Psychotherapy Track
2-year Psychodynamic Psychotherapy Track
This summary should not exceed ten double-spaced typewritten pages.
2. 2-year Track: Please include summaries of one adult or child case, which show your diagnostic understanding of the patient and the process of therapy, to be used as a basis for presentation to members of the faculty. The summary should not exceed ten double-spaced typewritten pages.

Cancelof

Autobiographical Essay
An autobiographical narrative to include the significant events of your life and the significant steps in your career, including any experiences and relationships which you consider important factors in having interested you in psychoanalysis.

Cancelof
Extra professional interests (hobbies, recreational pursuits, etc.)

References
Please list three individuals familiar with your clinical work and in a position to pass upon your qualifications as a possible candidate in psychoanalysis (e.g., supervisors or colleagues. May not be your current or former analyst/therapist). Give each of these individuals a copy of the Request for Letter of Reference form.

We may contact your references for additional information about your work. References can email their letters directly to the SDPC Admissions Director, Kristin Whiteside, PhD, at: admissions@sdpsychoanalytic.org.

You may submit your application prior to references being received so that we may begin to schedule your interviews. Your application is not considered complete until all your letters of reference are received. Applicants are responsible for checking in with their references. Please list your professional references below.
Full Name of Reference #1

First NameLast NameSuffix
Email of Reference #1
Relationship
Full Name of Reference #2

First NameLast NameSuffix
Email of Reference #2
Relationship
Full Name of Reference #3

First NameLast NameSuffix
Email of Reference #3
Relationship

Conditions, Attestations & Consents
I understand by checking the boxes below I consent to the following:
1) In applying to the San Diego Psychoanalytic Center (SDPC) Psychoanalytic Studies Program, I understand that SDPC's Admissions and Program Committee representatives or designees will review my application and references and may make further inquiries about me, including to my training programs/institutions or other professional settings, and that this information will be handled with discretion. I am not entitled to and will not ask for disclosure of these inquiries. I hereby release SDPC, its faculty, officials, employees, and agents from any liability in connection with the acquisition and use of said information and will hold them free from all damage and claims because of any action taken on this application or by reason of any subsequent action.

2) If accepted, I agree to abide by the rules and regulations of the San Diego Psychoanalytic Center as the same may, from time to time, be amended. I understand and agree that the continuation of my association with the Center, including the awarding of credentials, degrees, and diplomas, is in the sole discretion of the Center, and under no circumstances shall the San Diego Psychoanalytic Center, its officers, directors, faculty, employees, or members be liable to me by reason of any action or inaction in relation thereto. I further agree that, if accepted, I will not represent myself as a psychoanalyst to the public, or in any registries, directories, lists, or programs until after such time as the Center has officially notified me of my graduation from the prescribed and complete course of psychoanalytic training.
Signature

Clear
Date

MonthDayYear
Date
Affiliation: SDPC is fully accredited by the California Medical Association (CMA) and the California Association of Marriage & Family Therapists (CAMFT). SDPC is also a Member of the American Psychoanalytic Association (APsA) and the International Psychoanalytic Association(IPA), and is recognized by the California Board of Psychology, The California Medical Board, and the Board of Behavioral Sciences, as an approved provider of Continuing Education.

Non-Discrimination Policy: The San Diego Psychoanalytic Center (SDPC), does not discriminate on the basis of race, creed, color, sex, age, sexual orientation, national origin, or handicap in admissions, administration of its educational programs, scholarship, or employment.
Payment and Submission
Application Fee (non-refundable)
prevnext( X )
2- year Psychoanalytic Psychotherapy Application Fee*total incl. 3% processing fee
$125.00 Quantity
Item subtotal:$0.00

5-year Psychoanalytic Application Fee*incl. 3% processing fee
$200.00 Quantity
Item subtotal:$0.00

Subtotal

$0.00

Tax

$0.00

Total

$0.00

AUTHORIZATION AND RELEASE BY STUDENT APPLICANT

By applying for admission to the Adult Psychoanalytic Training Program of the San Diego Psychoanalytic Center, and ultimately for membership in the San Diego Psychoanalytic Center, I hereby authorize the Center, their faculty, the Administrator and representatives to consult with administrators, faculty members, and other representatives of institutions and organizations with which I have been associated or at which I have studied, and with other parties who may have information bearing on my professional competence, character, and ethical qualifications for admission to the Center, and successful completion of the curriculum and membership in the Center. I further consent to the inspection by the Center, their faculty, their Administrator, and representatives of all records and documents that may be material to an evaluation of my professional, personal, and ethical qualifications and competence.

I hereby release from liability the Center, its faculty, its Administrator, and its representatives for their acts performed in good faith and without malice in connection with the evaluation of my application and qualifications. I further release from liability any and all individuals and organizations who provide information to the Center, their faculty, or representatives, in good faith and without malice, concerning my professional competence, ethics, character, and other qualifications for admission to the Center, successful completion of the curriculum, and membership in the Center. I hereby consent to the release by those parties of such information.

I authorize and consent to the release by the Center, their faculty, their Administrator, and representatives of information concerning my professional competence, ethics, character, and other qualifications to other facilities, organizations, and interested persons, on request, provided such information is released in good faith and without malice. I further release from liability the Center, its faculty, their Administrator, and representatives for so doing.

I agree to abide by the Bylaws of the Organization and the Education Committee and Student Manuals (the "Manuals") regardless of whether I am admitted to the Training Program in all respects concerning my application, and, if admitted, agree to abide by the Bylaws and the Manuals, in all other respects.
Signature

Clear
Date

MonthDayYear
Date
File Upload

Cancelof
Should be Empty:

APPLICATION FOR ADMISSION TO THE PSYCHOANALYTIC STUDIES PROGRAM

Application for Psychoanalytic Studies Program

Personal Information

Address

Education

Medical School

Graduate School

Clinical Internships

Postgraduate Training

Academic Diplomas

Licensure & Certification

Malpractice Insurance

Curriculum Vitae (CV)

Current Clinical Practice

Teaching Experience

Supervisory Experience

Membership in Professional Organizations or Societies

Other Certificates

Professional & Ethical Practices

Professional & Ethical Practices...

Professional & Ethical Practices...

Professional & Ethical Practices...

Professional & Ethical Practices...

Terms and Conditions

Personal Psychoanalysis and/or Psychodynamic Psychotherapy Experience

Previous Psychoanalysis and/or Psychodynamic Psychotherapy Experience

Case Summaries

Autobiographical Essay

Additional Information

References

Conditions, Attestations & Consents

Payment and Submission