Meeting of the Psychoanalytic Association of New York

DISCUSSION: Dr. Robert M. Chalfin recalled his own experiences with peer review which involved mutual acting out of a transference-countertransference paradigm leading to an unworkable impediment in the analysis. In contrast, Dr. Rudominer was able to use the experience to achieve a successful analytic resolution through utilization of self-analysis and classical analytic technique. Dr. Chalfin felt that patients are entitled to make use of their benefits, and he advised a nonjudgmental approach to insurance coverage and forms. He called attention to the splitting of positive and negative feelings in the transference, as well as to the stimulation of sadistic and masochistic impulses. The situation was heightened for Dr. Rudominer by his being a candidate at the time of the peer review request. It is not surprising that at the beginning there is mutual collusion and acting out. The writing of an overly detailed report was unknowingly complementary to his patient's masochistic fantasies. Forced into activity by the insurance company, Dr. Rudominer first reacted with annoyance which led to a successful self-analysis and to eventual empathy and the ability to handle the variety of transference and countertransference manifestations by interpretation. Dr. Chalfin agreed with Dr. Rudominer that analysis of the handling of third party issues can sometimes be a window into the analytic process.

Dr. George H. Wiedeman described the Peer Review Manual and how it may err on the side of a "formidable" completeness that could lead to the disclosure of unnecessary details of a patient's life to third party payers. This brought up the issue of privacy and confidentiality. In writing reports (not peer review) for insurance companies, Dr. Wiedeman has kept them brief and has avoided mentioning any intimate and compromising data. He recommended having the patient read the reports before they are sent off. Not to do this leads to the confirmation of a frequent transferenc