At the 1978 Fall Meeting of the American Psychoanalytic Association in New York, certain findings concerning analysts' practices and attitudes were presented by a panel of members of a subcommittee that has been studying data from the 1976 Survey of Psychoanalytic Practice. The 7 A.M. meeting was surprisingly well attended by representatives of local societies and various categories of members. There was a lively exchange between the audience and the panel, the latter chaired by Dr. Daniel Jaffe and including Drs. Lee Brauer, Jose Barchilon, Maurice Friend, Theodore Jacobs, and Committee Co-Chairman Daniel Shapiro. Special data from the report will be elaborated on and forwarded to each local society for comparison with national norms.
Introductory remarks provided a brief review of information previously reported from the Survey (see Jour. Amer. Psa. A., 26:615-631, 1978; and Minutes of Meeting of Members, Appendix F: 48-60, May, 1978). In summary, the following points were made:
Over half of responding members have stable or increasing practices compared to ten years before. The mean was slightly lower, going from about 6 patients to about 5 patients in analysis, for active members.
In the Northeast and Far West, analytic patients were harder to obtain.
Different types of patients were being seen more often and more varied treatment modalities were being used, compared to ten years before.
About 1/3 of patients in psychotherapy would have been taken into analysis if economic factors had permitted. The remaining 2/3 in psychotherapy were considered unsuitable for analysis.
60% of graduate members were very strongly identified with analysis, 25% strongly identified, 15% less identified, some even alienated.
1/3 of active members had 7 or more analysands, 1/3 had 4 to 6, and 1/3 had 3 or less.
1/3 of active members who responded were training analysts, with a mean of 6½ analysands compared to 4 for non-training analysts.
However, the spread was 2 to 8½ analysands even for training analysts, depending on which local society one belonged to. A few societies had a mean of 7 cases in analysis for all active members (more than the training analyst mean nationally). More societies however had a mean of less than 5.
Several states were high, others low, with a range of 1½ to 7½ cases per analyst. Even within the same state or city, local societies differed widely in mean number of analysands.
Analysts with larger analytic practices a) received referrals from colleagues, former patients, and Society-Institutes; b) were active locally and in the American; c) were more strongly identified with psychoanalysis; d) believed in the efficacy of higher frequency of sessions for achieving analytic goals; e) showed an age difference since younger actives had more analysands than senior analysts.
A presentation based on the statistical study of career patterns followed, and emphasized the great diversity of careers of analysts, the significance of achieving training analyst status, and the impact of policies and activities within local analytic societies on strength of analytic practices.
The 1,306 analysts in private practice who were studied, spent a mean of 34 hours a week in office practice and 18 hours in other professional activities. Six distinct classes of professional activity could be identified: analytic practice, consultation, psychotherapy, non-individual therapy, academics-administration, and institutional therapy.
There seemed to be considerable overlapping and diversity among these types of activity, so that some analysts with active practices saw many therapy patients as well as analysands, while some wtih active analytic practices saw few therapy patients. The measures of rewards, satisfactions, and identification with the profession were strongly related to the type of activity pursued, and referral sources were similarly varied for the different categories.
In general, those with larger analytic practices (six or more analytic cases) were higher on all three measures: rewards (income, progress toward professional goals); satisfaction (with referrals and open time for cases); and identification (stronger than five years earlier). The most rewarded were those with larger analytic practices and those who spent more time in organizational and committee work, teaching, and administration. The least rewarded were those rendering patient care in institutional or community settings. The most satisfied with their practices were more likely to be involved in organizational work, teaching, administration, consultation, and analytic practice. Greater dissatisfaction was correlated with more psychotherapy and less analytic activity, and with more patients on medication. Lower identification with analysis as a profession, not unexpectedly, was correlated with higher psychotherapy activity. However, it was surprising to learn that those active as teachers and administrators and affiliated with medical schools (except for training analysts), were significantly less identified with analysis. Weakening of identification was prominent among those who did not follow a training analyst career after the age of 50, especially if they were active in medical school settings.
The study of referral sources provided further interesting findings. Almost one half of the patients in analysis were referred by another analyst. The other major sources, providing the vast majority of patients in analysis, were:
Psychiatrists (more than twice as many referrals to affiliates than to actives).
Self-referral or referral by relatives of patients (three times as many to actives as to affiliates or associates).
Psychoanalytic institutes or societies (twice as many to affiliates as to actives or associates).
Social agencies and mental health professionals supplied many analytic patients to associate members but few to actives; and more analytic patients came to associates and affiliates than to actives from physicians. Colleagues and candidates referred many analytic cases to associates. However, though all referral sources came relatively equally to analysts in all three categories of membership, 64% of affiliates received cases referred by other candidates while less than half as many came to actives and associates, indicating that candidates tend to support one another with referrals.
Factors related to large analytic practices are training analyst status, membership in certain local societies, referrals from analytic colleagues, and child analytic training. Although women were more likely to have had child analytic training than men, and were equally likely to be training analysts, they saw 20% fewer analytic and therapy patients. Though their income was 1/3 less, they were more satisfied with their referrals than were men.
Another topic reported on was related to factors contributing to high levels of practice and referrals in certain societies: Chicago, Denver, Cincinnati and St. Louis (discussed by Dr. Barchilon), and Downstate (discussed by Dr. Friend).
The Committee on Psychoanalytic Practice is continuing its studies based on the 1976 Survey, and will report next on patient data. At the same time, reports are being prepared that each local society will receive in the Spring of 1979, to provide data that can be used to compare their own situation with those in other societies. In this way we hope to continue the dialogue that was begun at the Panel meeting summarized above, and to better understand the variability in levels of practice, career patterns, and “outcomes” (rewards, satisfactions, identification).
Daniel S. Jaffe and Daniel Shapiro
Co-Chairmen, Committee on Psychoanalytic Practice