Past President of the American Psychoanalytic Association and current President of the International Psychoanalytical Association, Dr. Wallerstein is well known as an outstanding psychoanalyst. In this interview conducted at the December 1987 meetings in New York, Dr. Wallerstein talks first about his life as a psychoanalytic educator; then focuses on his many roles in our scientific community; and finally discusses the past, present, and future relationship between the American and the International.
Dr. Shane: Dr. Wallerstein, you've had a long and varied career in psychoanalysis. You've held many offices in the American as well as the International, culminating now with your Presidency of the International. And then, totally apart from your career with the professional organizations is your scientific interest, and particularly your interest in making psychoanalysis a scientific process. May we begin our conversation with how you became involved in the field?
Dr. Wallerstein: Yes. I went to medical school, like so many others in our field, with no intention of becoming a psychiatrist or psychoanalyst. I expected to be an internist. And after medical school and some internship, I was caught up in the army, as were all of us in my generation. I served as a physician in charge of an infectious disease ward and an electro-cardiography lab. It was only after my return for further medical training and the completion of my medical residency that I switched to psychiatry.
Dr. S: What prompted that?
Dr. W: That was one of the things I thought I'd find out a lot more about than I did in my analysis. I had all kinds of reasons, justifications, rationalizations, whatever. At the time I was at Mount Sinai in New York where I was the chief resident in medicine, headed for an NIH fellowship and an academic research career. I decided to switch at that point. I had a feeling—right or wrong—that within medicine, there were those who were at the forefront of what was of interest to me, and they were in academic centers, in laboratories, and in high-powered services at teaching hospitals. And there were all the rest who were in practice, doing very routine and often humdrum things of little intellectual interest. I had a vision that in psychiatry and psychoanalysis—and in those days, everybody I knew was going into psychiatry in order to become an analyst, there being no other real career in psychiatry in those days—I felt that in psychoanalysis, then, in contrast to medicine, the clinical work you did, the seeing of patients and the every day routine was also the place where the intellectual excitement was. And where the opportunities both to learn, and, if possible, to contribute, existed—right in the the clinical work. So I did switch.
Dr. S: So you wanted to do research in the clinical situation?
Dr. W: I wouldn't have dignified it by calling it research. I was interested in some kind of scholarly career. And I saw that in medicine it was separate from a life of practice, whereas in psychiatry, they were more naturally combined. So my switch came after completing my
medical requirements up to being board eligible in internal medicine. I went for my residency to the Menninger Foundation in the then newly-created School of Psychiatry. It was in 1949, when there were 100 residents in the Menninger School, and only 800 psychiatry residents altogether in the entire country. So, one-eighth of the country's psychiatrists were being trained in that one little town in the center of the country on the prairie. When I graduated, I was accepted for psychoanalytic training there.
Dr. S: The training must have been very competitively sought after with 100 psychiatric residents, most of whom wanted a psychoanalytic education.
Dr. W: Yes, so not all could get it in Topeka. Some scattered around the country, back to their home cities basically, to look for it there. Some couldn't get it at all. It was a highly competitive atmosphere for this most desired commodity. But I was accepted for training there, and got a job at the affiliated V.A. hospital running a psychosomatic service because of my previous experience in internal medicine. After a few years I created, with some others, a study of alcoholism, which became a book—in fact, the first book that I was a part of. Then some people at the Menninger Foundation itself became interested in me, and I was invited by the then chief of research, Gardner Murphy, to leave the V.A. hospital and come to work in the research department at the Menninger Foundation, while continuing my analytic training. I was both pleased and frightened at the prospect. I had never had a formal research job before. I found to my dismay that I was not only in the research department, but I also had the title of Assistant Director of Research—this was in 1954, at the beginning of my career, really— and I was expected to develop a clinical research program within a department which, under Gardner, had been more experimental in many of its thrusts. A group of us came together there and fashioned what became known over the years as the Menninger Foundation's Psychotherapy Research Project, put together in 1954 and 1955, and continuing uninterruptedly and in full swing for at least a decade and a half. I was able to garner a million dollars in research funding, a great deal of money at that time, which we spent at the rate of a hundred thousand a year, by means of which we could support, in those days, a large cohort of researchers, some full time; some, like myself, half time; and others, quarter time. Altogether there were between 15 and 20 people on the staff of this large, ambitious project, which has been written upon amply over the years, culminating in the book I wrote in 1981-82, Forty-two Lives in Treatment. But before that publication there were 60 to 70 individual articles written by myself and others, some singly-authored, some multiply-authored. And six prior books came from the project. The precursors of the project began in 1952, so we wrote about patients whose treatments go back to then, and whose treatment careers and subsequent life careers are followed. Just one or two things about the project. We were able to get 100 percent follow-up on our patients. That had to do with who they were, that they represented a highly visible group, not easily lost, the way clinic population patients can be.
Dr. S: Why so highly visible?
Dr. W: They were Menninger Foundation patients who came from all over the country, many from wealthy and well-known families. Some of them you'd recognize from the names of major industrial corporations in America. In that sense, they came from families that couldn't just disappear from view.
Dr. S: Yes, so that we learn differently than we do.
Dr. W: Yes. One of the reactions I've had to presentations of the material from this book, even before the book came out, was, “you've given us permission to do what we know we do, but haven't quite dared to acknowledge we do, because we were afraid we'd be criticized for doing not completely proper analyses.”
Dr. S: So people have been relieved by what you've come up with?
Dr. W: Some. And some have been upset.
Dr. S: There was another interesting outcome of your work: there were no analyses that didn't contain errors. That was another humbling aspect.
Dr. W: Well, you can put that another way. We, all of us, make mistakes. And our patients, by and large, live with and forgive us our mistakes. If they didn't, we d all lose our patients very quickly. As one of my colleagues, Ed Weinshel, puts it, our patients will almost always forgive us our mistakes of the head. They just won't forgive us our mistakes of the heart. And, taking that really quite literally, if we make mistakes of either omission or commission, failing to make the proper contact at the proper level with what's preoccupying the patient at that moment, the preoccupation comes back again, and the patient will give us another chance, an even more explicit one. So we have multiple opportunities to come back.
Dr. S: Otherwise, there would be less point in supervision, if you didn't think you'd have another chance at the same issue. What does it feel like having completed a 30-year project?
Dr. W: Well, you know, it's a little bit like a joke I heard about a grocery store in New Hampshire with a sign in the window: “This grocery store is a nonprofit enterprise. It wasn't intended that way.” When we got into this, we never thought it would be a 30-year project, as absorbing of all of our energies as it was. We started with two very simple, and perhaps simple-minded, questions. That is, as we lived in a big clinical institution that made its living on evaluating people who were coming from around the country, and treating them with all kinds of analytic psychotherapies, including psychoanalysis, we just thought we could learn more about what we spent our time doing—could try to learn more about two questions: First, the outcome question, in research jargon: “what changes actually do take place in psychoanalyses, and in psychoanalytic psychotherapies?; and second, the process question, “how do these changes come about, through the interaction of what factors—in terms of the patient, factors such as the organization of his or her personality, character, functioning, illness; factors in the treatment; factors in the therapist; and factors in the life situation—how, out of the confluence of all of these factors, do changes come about?” And so, it was research geared to finding out more about the processes and outcomes of the psychoanalytic psychotherapies. From this, it grew and grew. In trying to create a design to encompass it, more and more components got added, until it evolved into the very complex structure that it ended up being, occupying as many people as it did, over such a long period of time. Our problem was not patient attrition—we were able to hold the patients, learn about where 100 percent of them were at follow-up time. The more difficult problem was the potential for attrition of the researchers. Here was a group working together because their career patterns brought them at that time, to that place, with a shared willingness to work in that area, but with concentration on different aspects of it. Holding them together, as their own careers went on, and their interests took them in different directions, became a major thing. Over the years, some people dropped out and others came in. One not there at the beginning who became very central after a while was Otto Kernberg whose first job in America, when he came from Chile, was with the project. When I left Topeka in 1966, the project officially had had a 12-year life. But termination studies were still being done on some patients and on more, the follow-ups, quite a few of them, were still to be done. I left Otto behind as the principal investigator to get its final data gathering completed.
Dr. W: This, obviously, is one of the questions that preoccupied me in writing a book in the ‘80s about cases that had been evaluated in terms of the framework available to us in the ‘50's. There have been many developments in psychoanalysis since then, including Kernberg's work with borderlines; Kohut's delineation of the narcissistic character and the particular transference and countertransference problems evoked by those patients; Mahler's developmental studies, etc. All of that was either just beginning or had not yet even started. The patients were evaluated and studied, and predictions were made about them, in terms of the then prevailing ego-psychological metapsychology paradigm of Hartman, Kris, Loewenstein, Jacobson, Rapaport, etc.. How would it be done today, with our advances, not only in theoretical understanding but in technique? I'm not sure I, or anybody else, can have a definitive answer. I think some of the patients who weren't described in those words then would be described today as prototypical narcissistic or “borderline” personalities, although the word borderline was around—Bob Knight, who was in Topeka, had introduced it in the 40's—but it didn't have the complex layers of meaning Kernberg and others have given it since. It might well be that some of these patients, if they were seen today, would be delineated more clearly, and, therefore, more specifically addressed in treatment. And the sharpened view might then make some difference in the outcome. But I wasn't really convinced of that in any one single case, and I studied each one.
Dr. S: That's interesting. You could talk about a sharpened vision as an overview, but when you looked at each case, you had less conviction about what the new ideas might have contributed.
Dr. W: Yes. I wondered, could we really say that it would have been substantially different, or gone in different directions now? And I couldn't bring myself to say so. Any reader, by the way, can have the same opportunity. The 42 cases are each described at a particular point in the book in about a ten-page summary. And then there are many references to that patient throughout, with a concordance at the end, so you can look up any patient by their nickname or sobriquet, and trace down every place where they appear in print. Nonetheless, it is all culled down from much longer write-ups. The book got written during the two sabbatical years I've had in my career. The first year I took all of the data for each patient, which could literally include a thousand hours of process notes kept by that analyst throughout, and all of that data was boiled down to a case write-up on each.
Dr. S: Quite a task.
Dr. W: Yes. In the second sabbatical year, years later, I then took that material, sifting through it in a variety of ways, and organized it in terms of different themes and parameters, creating the book out of it. But those original case reports, averaging 60 double spaced pages each, are available to qualified scholars. I have one complete file. The Menninger Foundation, in two different places, has two other complete files. They are written in a uniform format, so that it's easy to compare them one with another—an accounting of this patient with this life history, and this type of personality, fell ill in the following ways, and came to treatment for these purposes. As we studied it, it was thought this would be the right treatment plan or course for this patient, with these projections and predictions for the course of treatment. All that is in an initial study. A second part of that write-up is a termination study—this is how the patient looked at termination, in light of this treatment, with a description of the treatment course and the treatment outcome. Predictions are made at termination time for the follow-up period. The third part reveals how it all looks at follow-up, with a retrospective view of the treatment period, as well as the intervening events between termination and follow-up. The fourth part contains an overall synthesis of each case, what we have learned from this case about changes that took place in this patient and how and why. The write-ups have been seen by some people already, and, in fact, some are being incorporated into a book, written by someone who had nothing to do with the project, but who is interested in just our psychological test protocols, taken before and after treatment and then at follow-up. In any case, people can look at those write-ups and answer any questions they have, including those you have just asked me.
Dr. S: It was truly unique training, the envy of everyone around. I remember how excited we all were about it.
Dr. W: Well, what will be left is a historical record. I have just edited, and written two chapters in, a book which chronicles the program, its conception, its rise, and its fall. Many of the old faculty and the student body contributed to it.
Dr. S: Whom do you think the readership of a book like that is likely to be? Dr. W: I'm not sure how large it will be. Those interested in education in the mental health field, that is, mental health practitioners, or those responsible for training programs, or those with academic positions where their department has some relationship to the mental health arena. I would hope it would be widely influential with that group.
Dr. S: Now I wonder if we might turn to the roles you've played both within the American and within the International. And then, in particular, I'd like to ask you about the ongoing relationship between the American and the International.
Dr. W: This is one area where I've had a unique vantage point. I've had a long involvement with both organizations. I became a member of the American in 1960, and began to attend the meetings of the American that year. It's worked out that I've been to every meeting twice a year since. Because I was in psychoanalytic research, and because the psychotherapy project for which I was principal investigator was at that time widely known, I was immediately invited to join the newly-initiated Committee on Training for Research, the forerunner of CORST. So I was on that committee over an 11-year span, almost from its very beginning, eventually becoming its chairman, and continuing as its chairman until I was elected President of the American.
Dr. S: What year was that?
Dr. W: I was President from 1971-1972. Up until then the main role I'd played in the American was as spokesperson for the whole research training enterprise within the American. I was also the first chair, subsequently, of the Committee on Scientific Activities, and then the first chair of the Fund for Psychoanalytic Research. These things were in a way spin-offs from my prior work. The role as spokesperson for research and research training was also, of course, political in that it was looked at by some as the back door for bringing non-medical people, or lay analysis, into the American. There was much opposition to the program, and concern about to what extent these people were truly researchers, and to what extent they were trying to sneak into clinical training under a research guise. The program had to be fought for and justified. Gradually, partly while I was still on the committee, and later in the hands of my successors, the criteria for acceptance were broadened from what originally had been limited to established researchers of national reputation, like George Klein, already midway in their life careers, to include younger people at the beginnings of their careers, where they had perhaps as much potential, but hadn't yet delivered on it, but who could be influenced from an earlier and more formative point in their careers. The name was changed to the Committee on Research and Special Training, CORST, to allow admission also to people who were not primarily researchers, but had academic positions of special influence, like a psychology professor in a university teaching analytic theory.
Dr. S: Really!
Dr. W: Yes, elected over and over again, until the 1950's, when an informal arrangement was worked out between the Europeans and the North Americans that the Presidency would alternate between the two regions.
Dr. S: I want to hear more about your own involvement, but before we get to that, perhaps you could say something about how the International is structured.
Dr. W: Of course. The President and the Treasurer are elected internationally. The Presidency had alternated, until the 1987 bylaw changes, between the two regions, Europe and North America. The Treasurer has always been an American because the treasury has been kept in the United States, with our dues collected in dollars. The Vice Presidents are also elected internationally, representing the different regions, and with the numbers gradually growing over the years. Up until the recent bylaw changes in Montreal, there were eight Vice Presidents, three from Europe, three from North America, and two from Latin America. The Council includes, in addition to these ten elected officials, the immediate past-President, Secretary appointed by the President, and four appointed Associate Secretaries, one from each of the different areas: North America, Western Europe, Eastern Europe, and Latin America.
Dr. S: So there were 16 on the Council altogether. What were the bylaw changes just voted in, and what is their significance?
Dr. W: There's a major structural reorganization going on within the IPA. One bylaw amendment equalizes the Vice Presidencies to three from each region, recognizing that Latin America, which has always been the third in size, is now the most rapidly growing region. Only seven or eight years ago the Latin Americans represented only 13 percent of the membership; at present they are 20 percent, and growing rapidly. And we are also now formalizing the rotation of the Presidency among the three major regions. My successor will be a European. But after that, the next President will be the first ever from Latin America. As I said, this was part of the bylaw changes brought to Montreal, voted by the membership there, sent out by mail ballot to the worldwide membership, and ratified overwhelmingly, with a greater return from the membership than we've ever had before on any bylaw changes. And in addition to these changes, a major alteration in the relationship between the American and the International was also voted. That relationship itself has a long history known by very few of our members. And yet, that history is crucial to an understanding of how things got the way they were, and the structural difficulties and impasses we had been in. Maybe it's a history worth recounting.
Dr. S: Most certainly.
Well, the IPA had its first international Congress in Salzburg in 1908, a handful of people Freud had invited to meet together from different countries.
Dr. S: And they had the treasury?
Dr. W: Well, they had the treasury, but at that time there was no treasury. Dues at first were five dollars a year, so the treasury didn't count for much. But the IPA would dissolve, and nobody in Europe wanted that. They wanted to maintain the structure. But they made a tremendous protest, so that while the Americans pressed very hard, there was enough European opposition to successfully put off a vote until the next Congress planned for 1940, when the American demands would be reconsidered.
Dr. S: But, of course, there was no Congress in 1940.
Dr. W: Yes, but the Americans began to act on their plan as if it had been passed officially. They also established at that time what was called the 1938 rule: people who had been trained in Europe before 1938, and were recognized by the International in a particular status, could carry that status to the United States. On that basis, people like Robert Waelder and Erik Erikson became members of the American. But then, after 1938, there would be no further training of non-medical people, nor access of non-medical people to membership in the American, because now the Americans controlled things internally within the United States.
The first chink in the armor against non-medical training came in 1956, 18 years later, leading in 1958 to the American's Committee on Training for Research, to which I was appointed in 1960. That was the first opening officially of any kind of training on any basis within the American for nonmedical people.
Dr. S: But what happened to the 1938 proposal?
Dr. W: Well, when the IPA met again for its first Congress after the war, in 1949, 11 years later, everybody acted as if it had been accepted. Nobody questioned it and in fact it was written into the IPA bylaws as if it actually had been formally voted. The Americans of course were still a majority at that time. And ever since then, from 1938 to 1987, one year short of a half century, we've been operating in accord with something that had never been formally ratified, but everybody accepted as if it had.
Dr. S: Nobody wanted to challenge this assumption?
Dr. W: No, because of the potential for divisiveness within the IPA. Under those auspices, then, the Americans built up the structure of the American, including the Board on Professional Standards, with its very close and intensive monitoring of standards, its hard work to make these standards uniformly high, and its creation of the greatest degree of excellence in training that it could. In the rest of the world, every other component society is responsible directly to the IPA. When there are troubles in the different societies, the IPA sends site visiting committees with authority to look into things, and to make recommendations. The IPA has never had such authority in relation to the American. Which meant that American members of the IPA could site visit in Europe and Latin America, but European and Latin American members never had a right to look at anything in the American. It was clearly an unequal arrangement, originally imposed by the American, in what was called the Regional Association agreement.
Dr. S: So what is the current status of the American vis-à-vis the IPA?
Dr. W: The American no longer has the majority membership in the IPA. They were the majority with two-thirds in the early '50's. The percentage has been gradually shrinking, because American psychoanalysis has been relatively stable. About as many new analysts come along as older ones retire and die. The overall numbers have hardly changed in a decade. And the rest of the world is growing rapidly. The biggest growth areas are Argentina, Brazil, France, Italy, and Germany. So the American is now down to about 33 percent of the world membership. And because the American has so many life members who don't pay dues, only 29 percent of the dues-paying membership of the IPA is in the American.
Dr. S: This is a really important change in status for the American.
Dr. W: Yes. It's no longer the giant that dominates everything. And so in that light, and as a consequence of the lawsuit, there have been intense discussions between the officers of the IPA and those of the American on how and under what conditions the two groups could remain together, so that psychoanalysts all around the world could maintain one international organization, and at the same time get out of a burdensome lawsuit which forces the rest of the world to support something that they personally don't believe in. And we came, after a series of meetings between the IPA and the American, to understandings that were agreed to last December (1986) in New York, and published in January, in accord with the IPA constitution and bylaws, in time to be voted on in Montreal in July (1987). This allowed us to head off what might have been a divisive, explosive Congress that could have torn the IPA apart.
Dr. S: So that this act of statesmanship was accomplished just in the nick of time.
Dr. W: It was literally in the nick of time. Last December in New York, we agreed on two things. One: in regard to the Regional Association status, to the American it was most important to preserve the internal autonomy and control over its training and training standards. It was willing to give up the other part of the Regional Association status, meaning the exclusive franchise, so that other groups outside the American could have access to the IPA, subject, of course, to the standards of the IPA which are really not different from the standards of the American. They're almost identical in their wording. The other thing agreed on by the American and the IPA had to do with keeping the IPA members from feeling financially penalized by a lawsuit to which their dues were being contributed. The American said, “Look, we have our own legal costs, which are much heavier than the IPA's. And we don't mind that our dues for the International are going to help pay for the lawsuit. So we will reimburse you for that percentage of payment for the lawsuit that comes from other than our dues.” At the time the understanding we were going by was our estimate that the Americans were paying about 40 percent of the dues and therefore of the IPA's legal costs. They agreed, then, to pick up 60 percent of the IPA's legal costs, the part that would otherwise fall on the other IPA members. Actually, it turns out the American got something of a bargain because it really represents only 29 percent of the dues-paying membership. Thirty percent would have been a more accurate figure for the agreement than 40 percent.
Now we're being confronted with something entirely new—well organized, functioning groups that may have 100 members (some of whom may even be IPA members already) and a 30-year history, with generations of students and graduates. Or they may have members trained by IPA members, fully in accord with IPA standards, only unofficially; or members trained by IPA members, but not fully in accord with IPA standards; or members trained by their own training analysts who are not IPA members. The IPA has a complicated process of evaluation ahead of us. We have set up a task force to help formulate guidelines on how to handle this.
Dr. S: What do you mean? Who set up a task force?
Dr. W: Basically as the President, the ultimate responsibility is mine. I make the appointments to the committee. It is chaired by Charles Hanly of Toronto, and includes David Sachs of Philadelphia; Janice de Saussure of Geneva; Moses Laufer of London; and Inga Villarreal of Bogota, Colombia. It's an international task force composed of individuals who have been involved with this aspect of the IPA, and who know it well, being charged with coming up with guidelines on how to handle organizations of this size and complexity, with such potential issues as what kind of grandfathering, and who should be grandfathered, and all of that.
Dr. S: Which is an enormous task.
Dr. W: Yes. They met all week here in New York. I met with them this morning. Then a total of about 40 people from the IPA, including the Executive Council, will meet for a week in England at the end of March, during which we will receive the recommendations of this particular task force, among other things, and will formulate and get the Executive Council to approve of the guidelines under which we will operate, so that we can begin to make site visits to some of these applicant groups in the late Spring.
Dr. S: What do you imagine the rate of new group memberships in the IPA will be? Will many be accepted at once?
Dr. W: They will be evaluated one by one. If there are enough people in a given group who meet the IPA standards and criteria, the group will become a member, and those people who meet the standards will automatically come into IPA membership by virtue of their membership in that group. We may, however, be faced with a situation wherein a group has two-thirds of its membership fully acceptable, meeting the IPA standards. But the other third may have various deficiencies in their experience, training, or whatever, that would need to be overcome. They as a group would have to face the problem of potential tension in their own ranks with the two classes of memberships thereby initiated, those who are members of the IPA and those who are not. Of course, the American's societies have lived with this a long time. Every local society in America has members who are not members of the American.
Dr. S: I guess you're saying that it's purely parochial for us to be concerned with psychoanalysis exclusively in America. If we're really concerned with psychoanalysis, we should be concerned with psychoanalysis internationally. And we shouldn't be so worried about the fact that we no longer have an exclusive franchise, that there will be analytic Institutes in the United States, not constitutents of the American, who will belong to the IPA, that such development shouldn't threaten us.
Dr. W: They shouldn't. The officers of the American determined that that was a change that they could and wanted to make. It was long overdue. It would tend to equalize things for the rest of the world. The American still has its internal autonomy in regard to training standards, and full functioning of the Board on Professional Standards, which is different from what exists in the rest of the world in its relationship to the International. But the situation is less unequal than it's been. And this has been accepted with great relief and gratitude around the world, as a strengthening of the IPA and our togetherness under that umbrella.
Dr. S: So you see the relationship between the American and the International as only being enhanced by these changes.
Dr. W: The officers of the IPA and of the American have been in full accord, really, on how we're proceeding together to further the interrelationship between us, to have the American feel more part of the IPA than in the past.
Dr. S: I guess we have you, in large measure, to thank for this. I imagine it would take someone with your years of experience in both the American and the International, and in psychoanalysis in general, to be able to help make such an equitable compromise.
Dr. W: It could well be. See, there are many people who felt no European administration could have worked out this agreement with the American, that it had to be an American administration, where the people could deal with their own friends, out of a common background …
Dr. S: … and a common sense of trust.
Dr. W: And a common sense of trust. With the happenstance of the lawsuit, and because of that, as well as because of the total reorganization we're going through just by virtue of the growth of the organization, we have moved from being a small club where everybody knew each other and everything was very informal to now 7,000 members in 36, 37 societies around the world on every continent except Africa, with problems and issues that differ in every place. We needed to be able to work well together to create the organization we required to function efficiently.
Dr. S: What about the theoretical variations that characterizes the IPA?
Dr. S: You have described these patients as more disturbed than neurotic, many of whom had to be hospitalized during the time that they were in treatment.
Dr. W: Right, They were in intensive analytic therapy, psychotherapy, or in analysis. But they were the kinds of patients who required, even during their analyses, periods of hospitalization, because their symptoms and destructive behaviors just got out of control. It was the sicker people who were sent to a place like Topeka in the first place; the psychiatrists who had seen them in New York, or Chicago, or wherever, felt they couldn't be managed solely on an outpatient basis. So, we did have 100 percent follow-up on them at the two or three year point. Eight of them are known dead now. There are probably more—this is, after all, 30 years after. But eight of the original 42 are known to be deceased. I know, as of a year or two ago, where half of the 34 others are, what they're doing, who they're in treatment with if they're in treatment, and how they're living.
Dr. S: Is this really the last of that project?
Dr. W: Yes. I, along with a small group of colleagues in San Francisco, am doing a successor project now, much more manageable in size and nowhere as ambitious in scope.
Dr. S: The monies wouldn't have been available now even if you had wanted to do something more ambitious.
Dr. W: Yes, the monies wouldn't be available, and also a project like that could only be done within that particular ecological climate. For instance, it rested on the fact that there was a cohort of patients being studied where we could count on and require the cooperation of all of their therapists. This is not something you can enforce in a private practice setting. But when the therapists are all on the payroll of a Foundation, seeing patients under the auspices of that Foundation, then both patient and therapist are subject to being involved. While there could be clinical contra-indications against studying a given patient, there couldn't simply be the feeling on the part of the therapist of, “I'd rather not be bothered,” or, “I'd rather you not look at my cases.”
Dr. S: The book Forty-two Lives in Treatment is interesting for a number of reasons. There's so much detail about each case, and you draw some fascinating conclusions about the work itself. Can you say something about that?
Dr. W: Yes. We, all of us, did get to know the patients well, just because there was an enormous wealth of information about each patient—the life history material that went into the initial evaluation; the data accumulated routinely in the course of analyses, including process notes and progress notes; and the intense additional interviewing and psychological testing upon termination and at follow-up. These data were first culled down into case histories written by me, and then further condensed into the summaries that appear in the book. So we did learn an enormous amount about these patients. What we learned from them, if you're interested in a paragraph overview, is that of these 42 adults, 50 percent men, 50 percent women, half were in analysis. Diagnostically, they ranged from normal-neurotic to much more severely disturbed patients who nowadays would be called borderline or narcissistic characters, and impulse neuroses of real severity. The results with the half that were analyzed ended up to be more modest than had been most optimistically projected. By the same token, with the other half who were in varying degrees of expressive or supportive psychoanalytic psychotherapy, the results often exceeded our initial expectations. In some instances this latter group reached the degree and kind of change that we had thought, a priori, would only have been possible with analysis. So, rather than diverging in the results obtained, the two groups of patients tended to converge. Moreover, we found that in looking at the dimensions which characterize an expressive analytic therapy or a more supportive one, the boundaries are not just more fluid than we had
thought, but there's more intermingling and fuzzing. Regularly, in the course of even those analyses that were kept, in the analyst's view, to the most classical model, there was a much greater infiltration of other technical maneuvers and a less pure, solely interpretive approach to the transference, defense, and resistance manifestations. To varying degrees, in all cases, some of the important factors we felt we could discern in the process and in the results obtained, and in the consolidation of those results, came from something other than the purely interpretive, insight-aiming aspects of the analysis. That is, there were always varying degrees of support in all 42 treatments. Most analysts will acknowledge such infiltration when they talk in the corridors about what they really do with their patients, but they usually don't dare put all of this into formal presentations.
Dr. S: I want to follow you from Topeka to San Francisco. But I want to ask you first one more question about the book. After all, you deal with analysis and psychotherapy done 30 years ago. Do you think there would be a great difference in the treatment offered this group, and that of 42 different patients seen today, in terms of the therapy they received?
Dr. S: A valuable resource, indeed. Well, to go back to your leaving Menninger's for San Francisco …
Dr. W: Actually, that was coming for a while. I went to Menninger's in 1949, and we finally left in 1966, after 17 years. I had been invited to the Center for Advanced Study in the Behavioral Sciences at Stanford, California for the academic year 1964-65. This was the first sabbatical year I spent working on the book, but also during that year we considered our future and for a variety of reasons decided to move. We went back to Topeka for a year, and debated between two possibilities, Boston and San Francisco, choosing ultimately Mount Zion Hospital in San Francisco where we moved in 1966, and I became Chief of Psychiatry from 1966 to 1975. In ‘75, I moved to the University as Chairman of the Department of Psychiatry at the UCSF Medical School, until ‘85. During this time I had a second sabbatical year, and completed the book. Since 1985, I have continued on as a senior professor without any administrative portfolio in the Department, doing the teaching, research and clinical work that I want to, under the best of all possible conditions.
Dr. S: Well, you've deserved it. It seems to me that your life during this last period can be viewed under three categories: the academic, the scientific, and the administrative. Looking first at the academic, you developed a very unusual program, the DMH, Doctorate of Mental Health. Maybe you could say something about that.
Dr. W: Actually, that had a prior history also. Lawrence Kubie, you know, had the idea of creating a doctoral degree in what he termed medical psychology. It was based on the fact that people come to clinical work from a variety of disciplinary backgrounds—psychiatry, clinical psychology, clinical social work—converging on a common psychotherapeutic field, where although individually different things are done, there are many areas of overlap. Each disciplinary background yields certain strengths and capacities, but leaves certain deficiencies. Kubie's original conception, published in 1954, was to create a graduate program to train a new kind of mental health professional. It would draw on the most relevant knowledge in the areas of biological science, psychological science, and social science, achieving some kind of fused amalgam of what people got through their traditional disciplinary routes, leaving out the things that were not relevant. It was an idea that was much talked about, but implemented nowhere. I personally became involved first in 1963 when I was invited to attend a conference with 30 to 40 people from different disciplines to talk about this new conception. Then, in 1966, I moved to Mount Zion, where I was chief of a department of psychiatry with a very active training program, with about 60 trainees, including psychiatric residents, fellows in child psychiatry, pre- and post-doctoral clinical psychology fellows, post-masters social work fellows, and pastoral counselors. This intensely interdisciplinary setting, within a very psychoanalytically oriented department where half of the staff were analysts, seemed to me to provide a climate very receptive to fashioning this ideal mental health training program. While it was at a time when, under the Nixon,
administration, there was a progressive cutting back of monies available for the traditional clinical training programs, we were able to get money to inaugurate this program from private foundations interested in medical and mental health education. We needed a five-year curriculum in which there would be two pre-clinical or basic science years under university auspices, and three clinical years, originally projected to be at Mount Zion, alongside the psychiatric residents. Liaison was established with the University of California at Berkeley, which inaugurated a master's degree program incorporating our preclinical curriculum for those first two years, which qualified the individual for nothing other than going on to the doctoral part of our program. In the meantime, the university recruited me to come as chairman of the department of psychiatry at the UC San Francisco School of Medicine and to bring this program with me. So suddenly the doctoral part became available under the auspices of the medical school. It took several years to work the whole thing through the university's bureaucracy to get a new degree established. Even universities that are politically radical are, in terms of their structure and bureaucracy, enormously conservative. It took hundreds of years for barbers to become surgeons, and we were trying overnight to bring a new profession with a new degree into being. And we succeeded. We started in the early '70's, and it got established by 1973. It had a 13-year run, with nine classes going through the five-year curriculum. And then a variety of forces led to the program's demise: economic pressures; adverse political pressures of the organized professions, psychiatry and medicine; and antagonisms within the university beaureaucracy itself. We graduated about 75 people in all.
Dr. S: In other words, the strategically placed individual.
Dr. W: Yes. That gradual liberalization happened. I was also known to have come originally from an institute in Topeka very friendly to, and receptive to, non-medical analysis. So although I got into CORST on a research basis, I also became identified at that point as someone occupied with, or preoccupied, with the nature of the American, and with access to training in the American of non-medical people.
I became President of the American in 1971-72. After that, I remained very active in the organization and in its committee structure; for one period I was on six of its major committees at the same time, and I remained on some for a long time, such as COPE, the Committee on Psychoanalytic Education, out of which our book on supervision, Becoming a Psychoanalyst, developed. I also remained for a long time on the Committee on Scientific Activities, the Fund for Psychoanalytic Research, and the Committee on University and Medical Education.
I started attending the International meetings with the 1967 Congress in Copenhagen, and I've gone to all the International Congresses since. At the 1969 Congress in Rome, I was invited to chair a panel on the relationship between psychotherapy and psychoanalysis.
Dr. S: Another major interest of yours.
Dr. W: Yes. That was the first time the International had discussed this topic which had before then been viewed as a strictly parochial American interest.
In 1975, under the Presidency of Serge Lebovici, I was invited to be the co-chairman, with Evelyne Kestemberg of Paris, of the Conference of Training Analysts, meeting for several days before the main Congress itself. I was asked to do that again in 1977 in Jerusalem as the overall chair, and then for the third time in 1979 in New York. By that time, I was heavily involved with the International. Going to all the Congresses, and having that role three times running in the pre-Congresses, I knew people from all around the world. So I was elected a Vice President in 1977, placing me on the Executive Council of the International. I was a Vice President for eight years, until 1985, with four successive elections to the position. That year, I became President of the International, and was reelected in 1987. It's a two-term sequence. You're expected to run for reelection, unless something happens. In the earlier days, things were much more informal. The first President was Carl Jung. And, then, when Jones got to be President,
he stayed, literally for life, for about 30 years.
Dr. S: What were the countries then?
Dr. W: Austria, Hungary, Switzerland, and Germany. That was it. That was the International. At the second Congress in Nuremberg in 1910, they formally organized the IPA, electing Freud's chosen person as the first President of this now international group. But the whole group couldn't have been more than 30 or 40 people, and it grew really slowly until World War II, meeting at intervals soon formalized as every two years. The first societies were organized in Berlin, Vienna, Budapest, and Zurich. Soon thereafter, the Dutch and the British entered. And then Americans began, a few of them, to go to Vienna, to be trained by Freud, and to come back to America. Two societies were organized originally, one in New York as the New York Society, and the other in Baltimore, as the American, which meant, basically, everybody outside of New York.
Dr. S: It's still a little that way, isn't it? New York is still quite prominent.
Dr. W: Well, you could say that. Ernest Jones was very instrumental in those early days, in Toronto, and in the States.
Dr. S: Now what year are we in?
Dr. W: We're up to the 1920's. And during this whole period, let's say into the early '30's, when Hitler came into power, the American analysts were only about 16 percent of the world's analysts. In Latin America, there was almost nobody. And all the rest were in Europe, mainly central Europe. With the march of Hitler across central Europe, things dissolved all over. The main centers in Berlin, Vienna, and Budapest were broken up. People fled, most of them to America. The remainder fled primarily to England, a couple to France, and one, Angel Garma, a Spaniard, fled a little earlier to Buenos Aires, beginning psychoanalysis in Latin America. This man had been trained in Berlin with Melanie Klein, and had been a college roommate of Salvador Dali's and Garcia Lorca's. When the Spanish Civil War came, Lorca was killed by the Franco forces. Garma was out of the country and couldn't get back, so he went to South America, and that's how it started there.
Others, including, of course, the Freud family itself, fled to London with Princess Marie Bonaparte's help. Melanie Klein had gone earlier in the mid-'20's, by invitation of the British. The ensuing tensions between the London school, meaning the Kleinians, and the Vienna school, meaning Anna Freud, has been written about in a long article in the International Journal—the history of the Controversial Discussions, with Jones, who had sided with Melanie Klein, being chided by Freud, who said, “You're ignoring my daughter, Anna.” But anyway, what happened with Hitler's coming, when the analysts all fled to the United States, the handful of American analysts was reinforced by this huge influx from Europe. According to Bob Knight's figures in his 1952 Presidential address to the American, of the over 700 analysts then in the IPA, two-thirds of them were suddenly in the United States, compared to the 1933 figure of only 16 to 20 percent. From the point of view of the survival of psychoanalysis and the psychoanalyst, of course, America had become the main haven, the new physical and intellectual home for the great majority of analysts, and some American analysts played key roles in helping the migration, in welcoming the refugees, and in providing this nurturing—and saving—environment.
Now, the American, from the very beginning, took a firm stand against any training of non-medical people, although in Europe, from the very start, analysis had been totally open to medical and non-medical people alike. And while there never was any deliberate intent at a quota of any kind, it seemed to work out both in England and in the other European countries that two-thirds were medical, and one-third non-medical, although in some countries it was closer to half and half. But the Americans, with their concern about the field being invaded by unqualified practitioners, wanted to keep it medical. This was a source of discomfort to Freud and those around him, but that's the way the Americans saw it. By 1938, the last prewar Congress, most of the analysts in the world were in America; then came World War II, following which, from 1938 to 1949, there were no Congresses. The Americans had come to this last pre-war, 1938 Congress with a proposal to abolish the I.T.C..
Dr. S: What was the I.T.C.?
Dr. W: The International Training Commission, similar in concept to the American's Board on Professional Standards, empowered to monitor standards and practices of training around the world. The Americans demanded at that time two things: First, the abolition of the I.T.C., because they wanted
to create their own monitoring body to supervise standards; they wanted total internal autonomy within the United States, with the International then accepting the Americans standards. That was one thing that was demanded. Second, they wanted an exclusive franchise, meaning that anyone wanting analytic training in the United States under the auspices of the International would have to do it through the American; groups outside the American could not have access to the IPA. So the American demanded an exclusive franchise and total internal autonomy as their price for staying in the IPA. The threat was the dissolution of the IPA, because by 1938 the Americans constituted the world majority.
Dr. S: Which wasn't an agreement.
Dr. W: But everybody assumed that it was. And, at that, the Europeans and the Latins always felt aggrieved, but the Americans were so powerful that to maintain harmony in the total world psychoanalytic family, the International went along. It's been the source of an uneasy tension, and over the years, different non-medical psychoanalytic groups, such as some of those that developed in New York, would make unofficial inquiries to the International about wanting to become members of the International. And each IPA president in turn would tell them, “No, you have to go through the American.” And where dissident groups, disaffiliating with the Component Society in other countries, could independently join the IPA, that wasn't possible either in America.
Dr. S: What influence, if any, did the lawsuit have on all of this?
Dr. W: What happened with the lawsuit is the following. The American, in March 1985, was sued by a group of psychologists who said, “we are representatives of a class of people who have been waiting many, many years to try to get some access to this training. We no longer think it's possible to do it through your processes; we're going to sue you under the anti-trust laws on an economic basis. You're restraining trade. You're depriving us of access to this livelihood. We're also suing the IPA, as a secondary defendant, because they allow you, as a constituent organization, to do these bad things.” In addition, for whatever the reasons, the plaintiffs also included the New York Society and the Columbia Group in the suit. That put the IPA in a very awkward position. On the one hand, the American was calling on the IPA to stand by it, as it stands by every other Component Society in the world. But lawsuits are very expensive. Colleagues in Britain and other countries were saying, “Look, we've never believed in this principle of keeping out non-medical people. A third or half of our members are nonmedical. You mean, we're supposed to pay our dues to help defend a lawsuit based on principles that are anathema to us? We don't want to do it. We don't have the treasury the American has. IPA dues are $100 a year. The American's are several hundred dollars a year. The American can levy assessments on its members, and its members have paid assessments. If you're a psychoanalyst in Calcutta, India, and your analytic fee is on average the equivalent of one or two American dollars an hour, a hundred dollar assessment is not something you can easily pay or would want to pay.
Dr. S: Especially if it's for something you don't believe in.
Dr. W: And so there was a tremendous explosive tension in the IPA over the involvement in this suit with the American. Many people were saying, “If the IPA doesn't disavow the American, or get out of the suit, we're going to do something.” The British Society was preparing a resolution to be introduced at the Montreal Congress saying, in effect, “If a component organization of the IPA gets into legal troubles in its own country over alleged violations of the law in its country, then it is its own responsibility to take care of it itself, and to hold the IPA harmless, and to reimburse the IPA for all expenses the IPA incurs.” This was saying, in effect, that the American would be required to either get the IPA out of the suit somehow, or pay all of the IPA's bills. Well, if that had ever come to the floor, it could have torn the organization apart. And the sentiment was strong and bitter on this issue. In Europe, training of non-medical and medical candidates has been on an equal basis all along. Latin America was different; in many countries it had started as only medical, and in some, the law of the country stated it had to be that way. In Argentina, for example, under the dictatorship, psychoanalysis has been declared an aspect of
psychiatry and a discipline available only to medical people. When the new government came in, they appointed a psychoanalyst to a very high position in the ministry of health, and stopped enforcing that law. So now, even in South America, non-medical people can be trained psychoanalytically on the same basis as medical people, but it's newer there than in Europe. Until the passing of the Gaskill Committee Report, the U.S. was alone, except for two small groups in South America, in maintaining a rule against the training of non-medical candidates for clinical psychoanalysis
Dr. S: So that's where the 40 percent figure came from?
Dr W: Yes. Those two compromises were proposed by the Executive Committee of the American as bylaw changes. This was shortly after, you should remember, the American's own passage by a 60 percent vote of its members, of the Gaskill Committee proposal to open the doors of the American to training of non-medical candidates for clinical psychoanalysis. This was the American's own reversal of the policy of exclusion of non-medical applicants set a half-century earlier. The British, when they learned of these new proposals from the American, withdrew their own proposal which would have split things so. And through a great deal of debate in Montreal, I think the principles at issue did get clearly enough articulated. The members in Montreal ended by quite overwhelmingly supporting the bylaw changes. They then went for ratification by mail ballot. Of the 4,000 voting members (full members) of the IPA, 1,000 voted, the highest number that have ever voted on a mail ballot. And on the response to the seven proposed bylaw changes, the lowest favorable response was 85 percent, the highest 95 percent.
Dr. S: So the membership was really in accord with the proposals.
Dr. W: Yes, with a minimum 85 percent vote in favor.
Dr. S: What do you anticipate will be the response of psychoanalytic training groups in the U.S. not belonging to the American?
Dr. W: There are many such groups around the United States. Some are functioning societies and institutes with training programs, with catalogues, with well-known people as members who contribute to the literature, that have been in existence for years outside the framework of the American. Others are five or six people who meet once a week to study analysis and who want to develop a training center. Currently there are 23 groups that have to this point contacted the IPA to say, “Under the new bylaw change, we'd like to make application for affiliation with the International.” Of the 23, 13 are in New York; five in Southern California (four in Los Angeles and one in Orange County); one in Denver; one in Chicago; one in Boston; one in Michigan; and one in Florida. The best organized, longest standing, most substantial, and with the most well-known figures are in New York. Up to this time, six of the 23 have sent well-documented inquiries to our central office in London, have been informed as to the kind of further documentation they need to provide, and are now in the process of gathering that material and sending it in. These will then be the first to be site visited and evaluated. The others may follow if their application material also warrants it. Basically the IPA is facing an entirely new kind of situation. What we are used to is different. I can take Peru as an example, the most recent component society to come into being. There were people in Peru who wanted to become analysts, but there was no training in Peru. Some went to Buenos Aires, some went to London. They went around the world, they got trained, and they came home, some five or six years later. They then said, “Now there are four of us who are trained by the IPA. We'd like to become a study group.” They are then visited by an IPA Committee, and if the Committee says, “Yes, there are four qualified people here and they are serious about it, they really want and have the capability to create a study group, a Sponsoring Committee is created to sponsor the development. This is akin to the way the American's Committee on New Training Facilities operates. Under the auspices of a Sponsoring
Committee, some of the four can be designated to have training functions. The group is charged with the task of developing a constitution, bylaws, and plans for a curriculum. The Sponsoring Committee is in on the selection of the candidates, making the final decisions. Through this process, people are brought in and begin to be analyzed. Classes start at some point. And as the years progress, either some new ones will come from overseas, or the numbers trained locally will grow in number. At the point at which there are ten, they can apply to the IPA to become a provisional society. And if they're accorded that, they can then select their own candidates and name their own training analysts, subject to later review. There is a final review before they become a full component society. The process can take up to 15 or 20 years, depending on the rate of growth in that country.
Dr. S: That's true. We have lived with two classes of membership for decades. But what do you anticipate will be the change the American will experience as a result of the restructuring of the IPA, and how might the relationship between the two organizations differ?
Dr. W: Well, I think what's come out of the lawsuit is a much greater awareness within the American of the interdependency between the American and the IPA. Now that interdependency has always been much higher in the consciousness of people in other places in the world. If you're in Venezuela, or Israel, or Australia, the big thing, other than your local meetings, is the International Congress every two years. To many Americans that hasn't been so because their central focus away from home is the meeting of the American. The IPA has been much more remote for many, except for those who go because the meetings take place in attractive cities in Europe, like Rome next time, where you can build a summer vacation around being at that Congress, and get certain tax benefits from it. More seriously, there have always been a goodly number of Americans involved in the IPA, but it hasn't been the central focus of each and every member, as it has been in other places in the world. What do the Americans get out of it? There are the individual benefits, such as “I go to the Congresses; I get a newsletter; I'm in an international roster; I'm now getting educational monographs and other publications in return for my dues.” But aside from the individual benefits, there is being a participant in an organization existing around the world that wants to give international unity and coherence to the meaning of being an analyst. If training standards can be truly broadened, universalized, if psychoanalysis can be promoted as it is now being promoted in Eastern Europe, and in other new areas that are coming into being—in Korea, for instance, there's a group that wants to come in—I think we should all be concerned that that training, whether it's in Korea, or in Czechoslovakia, or in the United States, is comparable enough so that it has a similar meaning. No matter where one is trained, one is trained to a skill in a discipline we can all share. Our standards should not be parochial and insular. And when we refer patients around the world, we can then have some sense of how the analyst works, and with what level of competence.
Another thing, the IPA has been very active in promoting psychoanalytic development, rebuilding it after World War II in Eastern Europe, behind the Iron Curtain, in a manner which was for a long time painfully slow. The first of these countries to officially recognize psychoanalysis was Hungary; there is now a functioning Hungarian Psychoanalytic Society officially permitted membership in our international organization. The psychiatrists who are members have jobs in mental hospitals during the day. The psychologists have jobs in mental hygiene clinics. But in the evening, on their own time, they are allowed to have private psychoanalytic practices if that's what they want to do. And patients are allowed to come and see them and pay fees, if that's what they want to do. It's now an officially acknowledged, recognized entity; psychoanalysis has been rebuilt in this one country in Eastern Europe. And for the first time since the famous Budapest Congress of 1918, there was an international Congress, Europe-wide basically, in Budapest, just this past month, where analytic colleagues came from all over Western Europe, but also colleagues, individuals, people in study groups, people who have been trained in other places, from Poland, from Roumania, from Yugoslavia, from Czechoslovakia, even from East Germany. So the East Germans and the West Germans talked to each other for the first time since World War II in open psychoanalytic discourse. And now all of this is under the sponsorship of the IPA, requiring time and energy including that of some Americans involved in the IPA, as well as money, to promote those
activities, to make sure that it's good analytic training, in accord with standards around the rest of the world. These are also things that Americans derive from being part of this organization.
Dr. W: That's one other aspect I should talk about. Psychoanalysis has been characterized world-wide by theoretical diversity. That hadn't been true in America. In America, it was more in Freud's idea or ideal of maintaining a mainstream which happened to be in our country the ego-psychological metapsychology paradigm. That paradigm was unchallenged in America except for a handful of Kleinians who came from London to live and work in Los Angeles. And then came the rise of Kohut. You know with the rise of Kohut, America has been confronted with an alternative theoretical position that has had an impact not just in this country but in other parts of the world, like in South, America, as well. On the other hand, other parts of the world have lived with this kind of diversity much longer. Britain has always had Kleinians, as well as the Anna Freudians, and in between them the so-called middle group, the object relations group. And there's been Bion, and there's been Lacan. In Latin America, they look at the American as a stagnant association; it doesn't grow. They ask: “Why are we growing in Latin America?” They answer, “Because we're party to the clash and diversity of all these theoretical perspectives, and we argue them out in our meetings. There's the excitement and the ferment that comes with that. And if America weren't so monolithic, it would be growing more too.” Whether that's right or wrong, whether it is simplistic or not, they have looked at what has been happening in America as bad for analysis. In America the views have been seen as too uniform.
Dr. S: Well, as you say, it's not true any longer.
Dr. W: Yes. Especially with Kohut. But now Americans are getting used to going to International meetings, where their perspective is confronted with a Kleinian or an object relations perspective and they have to see to what extent they look at clinical material similarly or differently. That will be the theme of the Rome Congress.
Dr. S: Tell me about it.
Dr. W: Well, it will take off from the Presidential address I gave in Montreal, entitled “One Analysis or Many?”, where the question was, how do we deal with the fact that we have a theoretical diversity, or pluralism within psychoanalysis, and yet we're all psychoanalysts? What is there that we share in common that makes us all analysts, despite our theoretical diversities, and that distinguishes us from those who are not analysts? Because not everything is analytic. That approach of mine was looked at by a number of people as a shift in emphasis from our differences to our common grounds. It was picked up by the Program Committee for Rome, where the theme will be “The Common Ground in Psychoanalysis”. There will be clinical presentations on successive days where each clinical presentation will be discussed by people of different theoretical views, to see how they look at these similarly, as well as differently. What do they have in common in the way they look at this clinical material? This will be the theme during the week and in the final summing up.
Dr. S: It sounds wonderful. It really does.
Dr. W: So come to Rome.
Dr. S: I definitely will. Well, thank you very much. This has been most fascinating.