The Final Report of the Committee on Psychoanalytic Practice was the main topic of discussion at the dinner meeting of Presidents and Presidents-Elect called by Dr. Gerald Freiman, chairman of the Committee on Affiliate Societies, on December 18, 1980. The discussion focused on the role the societies can play in improving their members' practices and in strengthening and maintaining their identity as psychoanalysts, especially for those not involved in institute activity.
Dr. Morton F. Reiser, President-Elect of the APsaA, told the meeting that the data obtained in the April 1976 Survey were a “very rich load of crude ore, with very little crude in it.” He felt it was handled so carefully statistically that “these are likely to be as good statistics as you can get.” Although the data were obtained almost five years ago, he believed there were “very powerful messages” in the report, and that from the standpoint of the market for analysis the situation now was probably no better and might be somewhat worse than it was then. He urged the assembled Presidents and their Executive Councils to study very carefully the preface, which spells out the biases, assumptions, and limitations of the Study. Although he had reservations about some Committee conclusions and recommendations, on the whole Dr. Reiser was “very, very impressed” with the Report, feeling that the study on which it was based went beyond generating hypotheses. Among the many issues raised by the study, Dr. Reiser singled out the diversity found in the careers of analysts and the mid-life crisis in their professional career. This mid-career crisis appears to be related to the degree of how much conviction analysts have about the value of doing analysis. It has an impact on their identification as analysts and possibly on the way they practice analysis.
Dr. Laurence Hall, chairman of the Board on Professional Standards, likened the work to that of anthropologists studying a subculture. The Report “tells us the way it really is out there,” as it discusses the life changes in doing analytic work. Not only does it make it possible to discuss locally the question of “where the analytic cases are,” but it gives each group basic information on its patterns of referral. Dr. Hall felt that self-study could be very useful, citing a Denver Institute survey conducted at the same time as the national survey, which showed that more than 70% of psychiatric residents in the area were already in analysis, and that more than 80% of analytic patients were professionals or family members of people in the mental health field. Concern about recruitment of candidates and of patients led to various institute programs to reach out to other sectors of the community and a broader base of referrals.
Returning to BOPS concerns, Dr. Hall worried about those who may graduate without conviction about the value of analytic treatment or theory, and the question of whether our training at times was less good than it could or should have been. Differences between espoused standards for frequency of analytic sessions and empirical practices are a source of BOPS concern, as are other Survey data on modifications of care.
Dr. Robert Michels, formerly Co-chairman of the Peer Review Committee, felt the researchers had established an investigative alliance between the Committee on Psychoanalytic Practice and the members of the APsaA, which should be the basis of an ongoing scrutiny by the profession of itself. He regretted that the primary basis of the study was “trade-union” concerns (“how is analysis doing”) rather than professional questions (“how good a job are we doing for our patients and society”). Still the study produced valuable findings, such as the asymmetric nature of our caseloads, the geographic maldistribution of psychoanalysts and their mobility patterns, which were quite relevant to our profession and impinged on matters of public policy. Dr. Michels, however, thought that scientific issues, such as the differential outcome of various forms of treatment provided by analysts, were given less attention. And he noted the absence of controls, wondering whether our mid-career crises were significantly different from those of comparable professionals such as trial lawyers. Now that the study has revealed the great amount of heterogeneity in the individual careers of analysts and in their group structures, it would be useful to have a closer look at career development and how we function in our groups. Access to treatment and treatment outcome issues emerge as a major responsibility of tremendous political importance, Dr. Michels said.
Dr. Herbert Gaskill, chairman of the Committee on National Issues, reflected on his experiences as an analytic pioneer, noting the need for confreres and for the support of a core group of analysts in a new community. Dr. Alex Kaplan, past president of the Association, spoke of the importance to the St. Louis Institute and society of an attitude of responsibility to the community, and of the community, in turn, having a responsibility to support psychoanalysis. This, he said, was not a public relations matter but of a basic orientation or philosophy. And, in a detailed exposition, Dr. George Pollock, past APsaA president and current Director of the Chicago Institute, described the broad range of programs reaching out into the community and the wide involvement of analysts in institute sponsored programs for teachers, academics, matrimonial lawyers, family court judges, psychiatric residents, physicians, social workers, and others. He reviewed the historical factors making for this ecology, and noted the tradition of time-tithing which enables the Clinic to provide 30,000 hours of low-fee analytic care a year to the community, obtaining in turn State of Illinois funding. The model of community responsibility and research into clinical care has been carried forward into settings where Chicago-trained analysts have moved, such as Topeka, Denver, St. Louis, and Cincinnati.
Members will have an opportunity to engage in a discussion of the issues arising from the Survey and the Committee's perspective and sometimes controversial recommendations at an Open Forum on Friday, May 8, in San Juan. The Open Forum will be chaired by Dr. Arnold Cooper, President of the APsaA. Discussion will be initiated by Drs. Hall, Michels, Moore, Reiser and Wallerstein.
The principal author of the Final Report was Dr. Daniel Shapiro, Co-chairman of the Committee on Psychoanalytic Practice, in collaboration with Dr. Daniel Jaffe, the Committee's Co-chairman, Dr. Lee Brauer, and Philip Leaf, Ph.D. The Report is the result of several years of Committee deliberations based on statistical investigations conducted at the Yale Computer Center by Drs. Brauer and Leaf under Dr. Shapiro's supervision. Copies of the Final Report were distributed to Executive Councilors, Presidents of. Affiliate Societies, Directors of Accredited Institutes, and Chairmen of relevant BOPS and Council Committees, and can be duplicated by the societies and institutes for use by members of the APsaA.