While my wife and I enjoyed a post-millennium dinner in New York's SoHo neighborhood, our companion uttered a prescient, if disheartening, predication about our discipline. Married to a psychoanalyst, the scholar in comparative literature quipped, “We share a devotion to dying professions.” Indeed, unless we immediately institute drastic reforms in training and certifying psychoanalysts, our wobbling profession will expire. It will die the same way Toynbee thought civilizations end—by committing suicide. The ever-louder voices heralding psychoanalysis' demise have become a deafening roar. Rangell (1974), long concerned with the field's future, believes psychoanalysis shares “the history of the 20th century: expansion, diffuse application, use and misuse, explosion, disaster” (p. 3). Holt (1985) writes, “the foundations of our house are tottering” (p. 305). Stepansky (2009) coins the word “fractionation” (p. xvii) and, along with Aron and Starr (2013), worries psychoanalysis' lack of coherence will bring its demise. In addition to the infighting evident in rivalries between professional associations, journals' editorial boards, and institutes, the field is increasingly attacked by better branded, mainstream treatments like cognitive-behavioral therapy (CBT) and psychopharmacology.
Although Zagermann's book focuses mostly on debates regarding the Training Analyst (TA) system, the title, The Future of Psychoanalysis, betrays its wider scope. I begin reviewing and commenting upon the book with the brief story of my own Certification and TA experience. Next, I carefully summarize, analyze, and synthesize the papers constituting Zagermann's book. I close by proposing a model for saving psychoanalysis based, in part, on the contributor's ideas. Although Zagermann's
collection of articles supposedly offered differing viewpoints on the Training Analyst (TA) system, most authors argue for its dismantling. Joining Kernberg (1986, 1996, 2000, 2014), they use phrases like “suicide prevention” and “twilight” when discussing its effect. Most suggest replacing the TA component of the tripartite model with a didactic psychoanalysis. Some wax poetically on the nature of the profession. Eizirik, for example, ends his chapter by citing a Brazilian playwright saying,
I am simply a man of the theater. I always was and always will be a man of the theater. Anyone capable of dedicating their entire life to the humanity and passion on these few meters of stage is a man of the theater. (p. 86)
We psychoanalysts also bring dedication, humanity, and passion to the theaters of our consulting rooms (Karbelnig, 2020). However, hope for our future rests not with reflective humanism but with political organization. Saving our profession requires fundamental, structural re-organization of psychoanalytic training processes. It requires development of an objective assessment of psychoanalytic competency. More on that soon but, meanwhile, and as promised, I share the story of my tortuous path to TA status. Robert Pyles, former president of the American Psychoanalytic Association (APsaA), suffered much like me. When a close friend of his asked him if preparing for Certification was neurotic, Pyles replied, “Neurotic? It was fucking suicidal” (p. 241). My tale, but one brief anecdote, symbolizes, like Pyles', the pressing need for change.
My achieving Certification by the APsaA, followed by anointment into the once-cherished TA priesthood, occurred in 2008. Regarding his similarly awful experience, Pyles cites Mark Twain's quip: Pyles cites Mark Twain's quip that the “primary difference between education and a massacre, is that a massacre is more sudden.” My massacre-like experience was definitely sudden. Worse, it was a poor assessment of competency. It felt more like a fraternity hazing. One of the cases I presented to the three-person panel, in written and oral form, concerned an analysand who had a sexual encounter with her previous psychotherapist. I reported that, because I was practicing as a psychologist in California, I handed her the pamphlet titled “Professional Therapy Never Involves Sex.” I described how I carefully considered the transference,
countertransference, and potential unconscious effects of presenting the document. In response, and as our two-hour in-depth discussion drew to a close, a classically trained psychoanalyst on the panel remarked, “Dr. Karbelnig, I find delivering your patient this pamphlet troubling.” I scrambled to reply. In the few minutes remaining, and while tremulous from the norepinephrine flooding my central nervous system, I explained I was required to provide patients victimized by a health care provider's sexual misconduct the pamphlet. Failure to do so risked charges of criminal misconduct. The examiner remained sufficiently disturbed to fail me. Although subsequently invited to submit another set of case materials and present for yet another interview, I instead wrote a detailed, angry letter explaining what appeared to be, at least, an unjust misunderstanding if not harassment or abuse. By return mail, I received the notification of my having been Certified. My experience, combined with countless similar stories from friends, colleagues, and Pyles himself, validates his belief the TA process has a “disastrous effect on our profession” (p. 223).
The contributors to Zagermann's book cover three central themes. They review the history of psychoanalytic training models; they critique the TA system, and; they (unwittingly) illustrate the problem with discussion itself. Most authors acknowledge how the Eitingon training model, introduced in Berlin in 1920, became the prototype for future psychoanalytic training programs. They agree the TA process has not significantly evolved since the reporting requirement ended. Garza-Guerrero compares and contrasts the Eitingon, French, and Uruguayan training models. Many contributors review myriad, failed efforts at reform, called for incorporation into universities, and suggested a greater emphasis on science.
All but three of the authors demand ending the TA procedure as it currently exists. Including the introduction, the book has 15 chapters. Twelve contributors emphatically recommend replacing the TA system with a didactic or personal analysis. Spoto seems ambiguous, thinking training should include a five-session-per-week analysis. De Filc, although requesting democratic reforms, shows ambivalence about TAs. Only Barros unequivocally considers the TA essential, writing,
“psychoanalytic education involves a great transformation of the candidate's emotional structure” (p. 185). The other contributors often use the same words—authoritarian, stultifying, hierarchical, cult-like, creativity-destroying, archaic, sectarian, abusive, infantilizing, anti-scientific, subjective, violent, arbitrary, secretive, competitive, dogmatic, inhibiting, and sadomasochistic—to describe the TA system's deleterious effects.
Most importantly, the articles themselves reveal the paralysis preventing psychoanalysis from maturing into an established, internationally recognized, and respected profession. Barros goes so far as to call for further examination of ideological, theoretical and philosophical bases of the TA concept. But, one wonders, when will examination prove sufficient? In isomorphic fashion, the book exposes the problem with organizing the psychoanalytic project: Unless a group of practitioners take radical, revisionist action, the field will remain plagued by well-meaning psychoanalysts who, while yearning for legitimacy, endlessly debate and deliberate. In confirmation, Bolognini advocates for adding a fourth element to the tripartite model, namely “the capacity to work together…” (p. xix). It is beyond ironic, even if accurate, for such a recommendation to require articulation.
Turning to the contributors, and beginning with Bolognini's forward, psychoanalysts surely need to be kinder and gentler but, in his view, integration into universities will not happen. The first chapter, by Berman, stresses his belief that psychoanalytic training institutions suffer the “Eitingon syndrome” (Zusman, 1988/2003, p. 353), an illness creating a hierarchical system of high priests and congregants. He cites Kernberg (1986) who writes, “idealization processes and an ambience of persecution are practically universal in psychoanalytic institutes” (p. 815). Years of intensive conflict ensued, Berman reports, as his fellow members of the Israeli Psychoanalytic Institute (IPI) addressed the TA system's inherent power differential. Infighting led to the expulsion of some candidates in the 1980s. The hierarchical rigidity began dissolving in the 1990s, although arguments lingered between the “traditionalists” and the “reformists.” The IPI barely avoided the outright splits occurring within many institutes. Ultimately, democratically determined reforms created a “less rigid, less hierarchical, and less persecutory” (p. 31) environment. Berman believes achieving TA status should require only five years post-graduation.
Blum describes the workings of Ernest Jones' “secret committee,” which convened after Jung's defection. Formed with Freud's consent, the group constituted “the aristocratic parents of the family romance of early psychoanalysis” (p. 37). This pattern, the Platonic ideal of repetition compulsion, replicated malignantly. Failure to achieve TA status, Blum thinks, created a caste system which “represented castration and narcissistic humiliation for the aspiring analyst” (p. 40). TAs became “special,” a self-perpetuating, self-selecting group, ultimately creating an “encapsulated, entrenched, narcissistic, controlling clique” (p. 41). Blum initially anticipates the IPA and the APsaA will agree on a means for standardizing the TA system. Later, though, his capacity for testing reality is restored. He calls such potential consensus a “noble concept,” a hoped-for “future reality” (p. 51), and one exemplifying why Freud considered psychoanalysis an impossible profession. Meanwhile, Blum also believes psychoanalytic institutes should automatically elevate graduates with five years of post-graduate experience to TA status.
Eisold critiques the common practice of psychoanalytic institutes empowering their education committees to evaluate candidates, approve courses, select faculty, and choose TAs in accordance with the Eitingon “gold standard.” He admires Kernberg's efforts, writing “his spirit of irreverence was perhaps even more striking and a source of hope for reform” (p. 55). Like many of his fellow authors, Eisold appreciates the buzz Kernberg creates but laments the lack of any meaningful change. It is ironic, he notes, that fewer patients seek psychoanalysis while “the demand for psychotherapy is rising and the need for mental health services is increasingly recognized” (p. 62). What needs to change? Eisold, too, calls for reforming the TA system, replacing it with a personal analysis conducted by “an adequately trained analyst” (p. 81). He darkly anticipates resistance, though, writing, “change must come, if only the slow change of decline and eventual failure” (p. 68). The next paper, by Eizirik, recommends integrating elements of the Uruguayan model with Eitingon's, also concluding, like Eisold, that any well-trained society member could serve as a TA.
Like Berman, Spoto acknowledges limitations in her viewpoint because of her primary experience with the British Psychoanalytic Society (BPS). Like nearly all other contributors, she laments the “loss of power and influence” (p. 92) of psychoanalytic institutions. Similarly echoing
her colleagues' cries, Spoto critiques the “reductive tribalism of ‘he is one of us’ or ‘she is not one of us,’ or ‘he/she is a real analyst’” (p. 99). Regarding the TA question, Spoto finds its status problematic. However, her position on the TA question is unclear. Regarding training programs, she writes, “for me, this includes five times a week training analysis” (p. 107).
The book's focus shifts with Garza-Guerrero's contribution. He pessimistically describes psychoanalytic education as existing somewhere between marginalization and irrelevance. He, too, thinks we need to bring psychoanalysis into the university system. Further, he writes, the field's cult-like origins require excision. The lack of systems for accreditation, certification, continuing education and re-certification threaten the discipline's future. However, with proper reforms, he believes the “ostensible syncretistic and dysfunctional activities should disappear entirely” (p. 130). He calls for creating “an international, truly facilitating and innovative committee for psychoanalytic training and research” (p. 128). He believes, as I do, that theoretical pluralism is the ultimate fate of clinical psychoanalysis. Organizational systems like the International New Groups Committee (INGC) strive to create an overarching accreditation system, he notes, but Garza-Guerrero considers them overly bureaucratic, dysfunctional, and expensive. His position on the TA system is crystal clear: “The training analyst system should be abolished” (p. 126), replaced by a didactic analysis conducted by any qualified psychoanalyst.
Next come the well-known students of psychoanalysis' unstable fault lines, Kernberg and Michels. Both men, actively involved in governance and education in psychoanalysis, suggest including more scientific training of psychoanalysts along with integration into the university system. They agree on the import of the training analysis but consider any graduate psychoanalyst qualified to provide one. They recommend psychoanalytic training focus on knowledge, technical ability, and the psychoanalytic attitude—meaning an understanding of the unconscious mind—and also incorporate modules on psychoanalytic psychotherapy. They propose establishing two new organizations.
Provocatively calling TAs a “roadblock in psychoanalytic education” (p. 161), Kirsner believes psychoanalysis' cult-like trends have led to crisis in, and decline of, psychoanalytic institutions. Such divisiveness
is problematic regardless of theoretical orientation, professional licensure, or geographical location. In reviewing the history of psychoanalytic training, Kirsner notes that short didactic analyses—considered adequate during psychoanalysis' early years—morphed into longer training analyses over the years. He critiques Fenichel, Gill, and Fleming (1980) who considered the TA, “a decisive person in the life of a candidate” (p. 25) (italics Kirsner's). Instead, he argues, TAs lead necessarily to a weakening of candidates' ego functioning and create “paranoiagenic institutions” (p. 173). Kirsner unequivocally advocates for the elimination of the TA system.
Turning away from the TA question and towards psychoanalytic education, Barros identifies critical points for reflection. He notes how IPA-approved models, Uruguayan, French, and Eitingon's, share basic tripartite structures. Their differences lie mostly in how they interrelate. Unlike many fellow contributors, Barros believes TAs define “the specificity of psychoanalytic practice and thinking in relation to other forms of psychological approaches” (p. 180). He considers a training analysis necessary to create a “great transformation of the candidate's emotional structure” (p. 185), considering it the “very condition for an individual to become an analyst” (p. 185).
Meyer psychoanalyzes the institutional enactment of the TA system itself. However, and revealing psychoanalytic scholars' urgent need for professional editors, he uses the Latin phrase, tout court—which means simply, or with no addition or amplification—at least 30 times. Tout court, Meyer critiques the “superior,” “aristocratic aura” (p. 198), hierarchical, and fetish-like nature of the TA, noting it fuses the infantile determinants of transference with ones created by the TA system itself. He writes, “The training analysis is not the ‘other person’ of the transference; he is always the same person, sustained by the institutional function” (p. 212). The resultant Oedipal triangle cannot be resolved because it is systemically embedded. In final conclusion, and boldly stating his position on the TA situation, he writes: “Training analysis is, as such, a singular illustration of the battle of psychoanalysis against itself” (p. 215).
Next comes Pyles' amusingly titled paper, “Still Crazy after All These Years,” in which he expresses unequivocal disdain for the TA system,
noting profession “can no longer afford it” (p. 223). He describes how the psychoanalysts founding the Psychoanalytic Institute of New England East (PINE) strived to avoid the TA trap. However, they ended up having the APsaA require them to adopt it. Together with Warren Procci, the APsaA president just before him, Pyles created the PPP proposal—a set of ideas for reforming the TA selection process—which was destined to “ignite another firestorm” (p. 243). The APsaA's Board of Professional Standards (BOPS) prevented any meaningful discussion of the PPP. He writes, “It seemed startingly clear once more that even the mere discussion of the TA system was incredibly threatening to the BOPS membership” (p. 243). The PPP proposal led seven members of the BOPS to file a lawsuit against the APsaA, its own parent organization. Pyles believes the BOPS leadership had been at the “forefront of APsaA's exclusionary policies for the past sixty years” (p. 245), creating “a complete stranglehold on training” (p. 245). He concludes again, “the training analyst system is a terrible one” (p. 249).
Working in the field since 1949, Wallerstein wonders whether or not organized psychoanalysis can ever create an optimal education. He calls for “a total demolition of the entire training structure” (p. 285), advocating replacing it with one emphasizing eight components including university affiliation, training in psychoanalysis and psychoanalytic psychotherapy, addressing professional affairs, treatment and research components, fundraising, and long-range strategic planning. De Filc's chapter traces historical changes and transformations in psychoanalytic training, recommending such reforms as the increased use of instructional technology and remote learning. Joining Bolognini, she also believes we psychoanalysts, a la Rodney King, need to get along better. She calls for “democratic institutions that are open to dialogue within and without them” (p. 295). On the one hand, she endorses a less rigid training system including a personal analysis. On the other hand, de Filc fails to take a clear stance on the TA question. She concludes by writing, “Only by being open-minded and receptive to the outside and to the inside—by giving all our members and candidates a voice—shall our institutions continue to be living, dynamic entities” (p. 308). Her tone, like that of many of her co-contributors, emanates kindliness, well-meaning, and care. In the final analysis, though, it represents just more talk. She offers no real, actionable proposals for change.
Zagermann deservedly renders his chapter, “theses on the heart of darkness,” the final one. He considers the TA system a “pathological institutional structure” (p. 326). As long as it remains, he argues, no creativity and forward movement can occur. He, too, identifies how unresolved Oedipal themes create a two-tiered hierarchy in psychoanalytic institutes. TAs have symbolically resolved the Oedipal struggle, he notes, while non-TAs are relegated to an infantile position. Also, and most interestingly, Zagermann highlights the incestuous problem inherent in psychoanalytic training. He writes, “incest—because of the exclusion of the third—is the psychic signature of infertility, and, thus, of agenerativity and anti-generativity” (p. 320). His proposed solutions? Immediately cancel the local privilege of nomination for TA, and replace it with a system in which individual institutes promote qualified TAs who are later certified by a national organization. Like many of his co-authors, Zagermann's tone is gloomy. He laments the lack of reforms, the historical break-ups, and the “indisputable dimension of perfidy and vileness when these conflicts are in process or are being suppressed” (p. 316). Calling for a more democratic training system, he considers current training operations, overseen by TA-dominated training committees, as “a demonic power, which, once erupted, can hardly be tamed…” (p. 326).
Having critically reviewed the articles filling Zagermann's 351-page book, readers comprehend the problem with psychoanalysts' propensity to talk, ruminate, and obsess. It is an organizational hazard. We spend our professional lives reflecting, dissecting, reviewing, and discussing. With all due respect, the book itself demonstrates why efforts to create a widely-accepted, respected profession of psychoanalysis fail. Echoing how attorneys' characters stunts growth in the realm of therapeutic jurisprudence, psychoanalysts' styles cause more argument than action. Barros, for example, wants still further discussion. De Filc investigates many interesting concepts—none translatable into achievable tasks. Professions like medicine, law, and accounting created accrediting and certifying agencies with facility. Why? Their forward movement was not retarded by interminable dialogues. Their ranks include persons with the organizational and political skills most psychoanalysts lack.
Pyles' and Wallerstein's articles validate our field's failure to create a credible profession. Garza-Guerrero's call for “an international, truly facilitating and innovative committee for psychoanalytic training and
research” (p. 128) remains unanswered. Emerging from the ashes of the BOPS lawsuit, the American Association for Psychoanalytic Education (AAPE) now exists. However, only seven of the 31 institute-members of the APsaA accept its terms. Outside of the APsaA, the Accreditation Council for Psychoanalytic Education (ACPE) has also appeared. It, too, has a marginal following. Garza-Guerrero believes the International New Groups Committee (INGC) is overly bureaucratic, dysfunctional, and expensive. None of these organizations address certification. Like many cited above, and as Garza-Guerrero proclaimed, our discipline will indeed “continue to struggle with marginalization and irrelevance” (p. 133) until, at the very least, psychoanalysis establishes a legitimate international accreditation and certification agency.
By separating the clinical from the theoretical, as George Klein (1976) did a half-century ago, creating a psychoanalytic profession becomes less complicated. A new international organization tasked with certifying psychoanalysts, and accrediting training institutions, need concern itself with clinical practice alone. Just like how physicians practicing medicine differ from those running research laboratories, clinical psychoanalysts form a category different from academic or research psychoanalysts. In truth, they already practice a distinct profession. They share expertise in a unique transformative method, generally working in more similar than dissimilar ways.
Regardless of theoretical preference, for example, psychoanalysts utilize three basic professional behaviors: framing, presence, and engagement (Karbelnig, , 2018a b). They frame their psychoanalytic interpersonal relationships by establishing, maintaining, and creating environments facilitative of psychoanalytic processes. They bring their presence to patients through empathy, attention, attunement, interest, respect, curiosity, and similar behaviors. (Interpersonally or relationally oriented clinicians believe presence contributes to transformational processes). Finally, psychoanalysts engage their patients in forms of dialogue, consciously and unconsciously, verbally and nonverbally, and in other, more mysterious ways, such as through “reverie” (Bion, 1963, p. 19). Prominent among psychoanalysts' many transformation-facilitating effects, engagement processes access, disrupt, and alter unconscious or other denied or disavowed features of mental life.
To avoid entrapment in bitter controversies regarding session frequency, theoretical preference, or use of the couch, the new agency would define competency in psychoanalysis as the capacity to facilitate psychoanalytic processes whether they be once-a-month or five-times-per-week. This simple modification would instantly transform clinical psychoanalysis from an exclusive to an inclusive profession. Clinicians practicing weekly psychoanalytic psychotherapy, or those who restrict their practices to psychoanalytic sessions four- to five-session per week, gather under the same, large tent. Expanding inclusivity still further, the new psychoanalytic profession would necessarily adopt Wallerstein's (2013) idea to utilize the psychoanalytic opus a source for a “plethora of theoretical metaphors” (p. 36). Accepting the fundamental architecture of framing, presence, and engagement, and including a wide range of theoretical models for facilitating patients' self-understanding, empowers, grows, and broadens the profession of psychoanalysis. If demand to formalize differences in theory or session frequency remains, individual institutions could create additional endorsements, i.e., in Kleinian, Lacanian, or Self-Psychology psychoanalysis. These added layers of authority could, for example, mandate theoretical orientation, the use of the couch, or a certain session frequency. Meanwhile, however, the field would take a giant leap forward by creating one psychoanalytic profession.
Saving psychoanalysis as a profession requires colleagues with an interest in systems, organizations, and politics to work in earnest to create an independent, non-profit, international agency tasked with credentialing psychoanalysts and accrediting training institutions. The world's major professions evolved in similar ways, establishing longstanding norms. After initially forming guilds or professional membership organizations, they outsourced accreditation and certification processes. Physicians in the United States, for example, receive a standardized training, take a national exam, and are then licensed by their individual states. The certifications they obtain in specialties are overseen by agencies different from licensing bodies. For the profession of psychoanalysis, Kernberg and Michels recommend two separate education and certification boards. However, no reason exists to complicate matters by having two agencies with closely related functions. I recommend psychoanalysts interested in creating a profession take these three basic steps:
First, invite the vast majority of practicing psychoanalysts, those who completed basic psychoanalytic training and practice clinically, to join the new organization. By passing a basic screening process, these founding members would be grandfathered in as certified psychoanalysts. The selection process should be liberal, drawing together psychoanalysts with diverse orientations, i.e., Freudian, Kleinian, Jungian, Intersubjective, Relational, etc. Some readers might react with horror to the proposal, worrying about degrees of experience, quality of training, or differences in theory or practice. However, broadly inviting psychoanalysts into a new organization would allow for the democratic development of certification and accreditation procedures. Unfortunately, some highly qualified psychoanalysts will refuse to join. Some marginally qualified ones will eagerly apply. However, these extremes will ultimately balance out.
Although the new organization might seek input from APsaA or IPA, the time for these membership organizations to assist in developing the profession of psychoanalysis has long passed. Historically, these organizations would have been responsible for spawning the profession. Clinical psychology, for example, arose from the ashes of WWII. An insufficient number of psychiatrists were available to treat traumatized soldiers, creating the need for additional clinicians. Early clinical psychology practitioners, simply holders of PhDs in psychology, developed into a guild later called the American Psychological Association (APA). The APA, continuing to function as a professional membership organization, ultimately spawned separate organizations for accrediting educational institutions and certifying competency. Membership functions differ from, and conflict with, accreditation and certification procedures.
Second, members would proceed to develop methodologies for assessing competency. They would need to address wide variations in training. In the United States, for example, mental health practitioners include psychiatrists, psychologists, licensed clinical social workers, marriage and family therapists, and licensed professional counselors. Comporting with the norms of other professions, the new agency might consider a post-graduation, two-part assessment of competency like this one:
A written exam assessing understanding of general psychoanalytic ideas such as the history of the field, the dynamic unconscious, repetition compulsion, transference, countertransference, interpretation
of dreams and other signs of the unconscious, defense mechanisms, and models of psychological development.
To accommodate candidates preferring written to oral expression, a second section of the evaluation process could consist of either:
An oral examination of psychoanalytic case presentations or;
Submission of a paper describing the course of a psychoanalysis and/or a psychoanalytic psychotherapy case.
Third, and drawing on certified psychoanalysts' skill set, the organization's members would develop processes for accrediting psychoanalytic institutes. Embracing the need to move forward quickly, and mirroring the liberal grandfathering in of most psychoanalysts as certified, many psychoanalytic institutes would similarly be accredited. The new professional psychoanalytic organization—strengthened by a large cadre of certified psychoanalysts and accredited institutions—could then carefully develop a standardized methodology for psychoanalytic training. What might training programs encompass?
As most contributors to Zagermann's book agree, psychoanalysts learn best through a variant of the tripartite model, namely didactic training, supervised practice, and their own psychoanalysis. The tripartite model could remain intact, but training analyses would be replaced by didactic ones—a modification supported by the majority of Zagermann's contributors. A didactic analysis might be defined, for example, as a minimal three-session-per-week analysis conducted for at least 18 months, by any certified psychoanalyst. In terms of control cases, and consonant with Eisold's and other's ideas, training institutions might require only one psychoanalytic control case. They could allow psychoanalytic psychotherapy processes to comprise the other one or two cases. Finally, and to address concerns about some candidate's lack of education in basic mental health issues, e.g., psychoanalysts with academic backgrounds, training institutions could offer a separate group of courses comparable to a post-baccalaureate pre-medical program. These tracks would educate in the basics of psychiatric diagnoses, risk assessment (suicide, homicide, or grave disability), the utility of psychological testing, basic information about psychotropic medications, etc.
Given the grave condition of our profession, those interested in developing such a proposed professional organization need to stop reading and start acting. The goal may be easier to achieve than most think. In any event, it has now become imperative. The Red Queen from Alice in Wonderland illustrates a basic truth: evolve or die. The recent BOPS versus APsaA lawsuit brings the shocking dysfunction of the psychoanalytic membership organizations to new, Kafkaesque heights. For years, APsaA demonstrated exclusionary politics beginning with the only physician-requirement in the world, progressing into the exclusionary membership arrangement between APsaP and the IPA, and continuing into the 1988 lawsuit ending the medical degree requirement. Most recently, the APsaA nearly destroyed itself with the embarrassing intramural BOPS litigation bleeding more than $1 million in legal fees. Meanwhile, no forward movement in establishing psychoanalysis as a credible profession has occurred.
Dominance hierarchies have always, and will always, exist. As the Soviet experiment revealed, it is impossible to completely eliminate social, economic, or cultural inequalities. Even the most progressive political scientists consider completely abolishing inequalities a utopian fantasy, an impossibility. Within psychoanalysis itself, even with a new organization, inequalities will persist. Some certified psychoanalysts will have busy practices; some will excel in publishing or lecturing; some will be more popular with supervisees than others. Nonetheless, this proposal for establishing an international organization for assessing competency in psychoanalysis and accrediting psychoanalytic educational institutions would eliminate the worst destructive inequities lingering within psychoanalysis. Most importantly, it would establish a real profession of psychoanalysis.
The history of “yapping dogfights” (Friedman, (2006), p. 689), the fears of marginalization, the calls for suicide prevention, and other dire predictions for psychoanalysis' future underscore the need for more professional organizing than further debate. It brings the 19th century's union organizer, Joe Hill, to mind. Years after Hill's 1925 death, Joan Baez turned a memorial poem by Alfred Hayes into the song, I Dreamed I Saw Joe Hill Last Night. The lyrics describe Joe Hill appearing in a dream, “alive as you and me.” He preaches organization, not mourning, and cries, “takes more than guns to kill a man.” It will take more than
CBT and psychotropic medications to kill psychoanalysis. Meanwhile, and for those readers with the systems, organizational, and political skills required to create a new profession, the time has come to set aside this review, open your computer, pick up your phone, get out your letterhead, and begin organizing a new psychoanalytic professional agency.