To the Editor:
In the September, 1974 issue, the article entitled, “Effects of Peer Review on Psychoanalysis” includes a number of statements which, it seems to me, typify some attitudes which both our medical colleagues and the public at large take exception to, with good reason in my opinion.
The first paragraph states that our organization “has had a long and highly disciplined tradition of peer review.” While this is true of training, peer review refers not to training but to practice, and in practice we do not have any tradition of peer review.
With regard to the argument that “peer review would improve some of the worst practitioners” it is stated that “this argument is irrelevant to our organization.” Every practitioner knows that we have our share of fools and rascals.
It is stated that consumer input “is especially complicated in our field because of the transferential phenomena.” That is undoubtedly true but what is omitted is the statement of counter-transferential phenomena, and it is precisely the latter which constitute one of the important reasons that peer review is necessary in our field too.
It is furthermore stated that transferential phenomena “involve unconscious processes which can only be understood by those who have already experienced them in the analytic situation.” This smacks of the old notion that only a psychoanalyst believer initiated in this secret and esoteric art can appropriately evaluate psychoanalysis.
The article states that because psychoanalysis is a research as well as a treatment modality, it “presents subtleties when assessments are made that non-analysts may not comprehend or approve.” There is a pretty clear implication that some patients may be taken into analysis for research purposes. While that may also be true, does it not raise a serious question of whether they should be charged usual fees?
The article, of course, does make many points which are valid and correct, but I believe that as a profession we should reexamine our attitudes in relation to those which I have criticized.
Sincerely yours,
Merton M. Gill, M.D.
Chicago, Illinois